Management of giant cell tumors of the distal radius

Abstract

Background: The distal radius is the most common location for giant cell tumors (GCT) in the upper extremity. Treatment should balance the goals of maximizing function and minimizing recurrence and other complications. Given the complexity in surgical treatment, various techniques have been described without clear standards of treatment.

Objectives: The purpose of this review is to provide an overview of evaluation of patients presenting with GCT of the distal radius, discuss management, and provide an updated summary on outcomes of treatment options.

Conclusion: Surgical treatment should consider tumor Grade, involvement of the articular surface, and patient-specific factors. Options include intralesional curettage and en bloc resection with reconstruction. Within reconstruction techniques, radiocarpal joint preserving and sparing procedures can be considered. Campanacci Grade 1 tumors can be successfully treated with joint preserving procedures, whereas for Campanacci Grade 3 tumors consideration should be given to joint resection to prevent recurrence. Treatment of Campanacci Grade 2 tumors is debated in the literature. Intralesional curettage and adjuvants can successfully treat cases where the articular surface can be preserved, while en-bloc resection should be used in cases where the articular surface cannot undergo aggressive curettage. A variety of reconstructive techniques are used for cases needing resection, with no clear gold standard. Joint sparing procedures preserve motion at the wrist joint, whereas joint sacrificing procedures preserve grip strength. Choice of reconstructive procedure should be made based on patient-specific factors, considering relative functional outcomes, complications, and recurrence rates.

Fig. 1

Example of a Campanacci Grade 3 GCT of the distal radius. AP (A) and lateral (B) radiographs demonstrate classic eccentric, lytic lesion in the distal radial metaphysis and epiphysis with soap-bubble appearance, expansion of the bone, and thinning of the cortex with a volar soft-tissue mass.

Fig. 2

Preoperative AP (A) and lateral (B) radiographs of a patient with a Campanacci Grade 2 GCT of right distal radius. Patient underwent curettage with hydrogen peroxide and argon beam adjuvants (C) followed by fixation with cement and volar plate (D). Post-operative radiographs show cement packing and stabilization of the right distal radius with supported articular surface (E, F).

Fig. 3

AP (A) and lateral (B) radiographs of a Campanacci Grade 3 GCT which was treated at an outside facility and underwent 4 sperate curettage procedures over a 3-year time period secondary to recurrences which were treated with cement and plate fixation (C and D). He subsequently presented with additional recurrences and was treated with treated with resection (E) and radiocarpal arthrodesis with vascularized fibula autograft. Post-operative radiographs 6 months after the arthrodesis procedure show union of the fibular autograft, radius, and carpus (F, G).

Fig. 4

AP (A) and lateral (B) radiographs of a Campanacci Grade 3 GCT which was treated with resection (C) and osteoarticular allograft reconstruction with compression plate fixation (D). Immediate post-operative radiographs show sparing and reconstruction of the radiocarpal joint (E, F). Four-year post-operative radiographs show solid fusion but also radiocarpal degenerative changes (G, H).

Fig. 5

Although not commonly utilized, following resection of the distal radius and proximal fibular autograft reconstruction can be utilized with the tibiofibular joint articular surface replacing the radiocarpal articulation (A, B). Twenty-four-year follow-up radiographs show retained proximal fibula autograft with moderate degenerative changes throughout the carpus (C, D).