Giant cell tumor or GCT of bone is a benign tumor but a locally aggressive one with the tendency for recurrence locally. One of the methods used in treatment of this tumor is resection Reconstruction of the tumor.
Materials and Methods
The distal radius is operated by en bloc resection of the tumor and is followed by the reconstruction of gap using autogenous fibular graft that is non vascularized. The articular surface of head of fibula will be placed over the surface of scapho-lunate articular and fixed to carpals, with 1 or 2 K-wires of 1.5 mm inserted obliquely. The excised end of radius and transplant will be fixed using small DCP that take 12 cortices fixation. Lateral ligament of wrist will be created by joining the part of fibular collateral ligament. One more K-wire will be inserted transversely in order to stabilize newly made fibulo-ulnar joint.
Bone grafting known as Iliac cancellous will be done routinely at host-graft junction. Limb will be immobilized in long arm cast for eight to ten weeks and will be followed by one forearm brace. This will be done after K-wires removal for facilitating mobility. Protected brace will be continued for another fourteen to sixteen weeks until the solid union is achieved radiologically. A minimum two years of followup are included in this. Routine radiographs should be taken at 3 monthly intervals for 1 year and thereafter each six months in order to exclude the probability of local recurrence.
Advantages of Resection and reconstruction method
Resection of distal radius and the reconstruction using autogenous ipsilateral fibula that are non vascularized offers many advantages like congruency of the carpal joint being more, rapid incorporation as the autograft and also easy accessibility avoiding significant morbidity in the donor site. Structural changes are also minimal. Immunogenic reactions are also absent and the facilities for bone banking or procedures for graft matching are not needed. Vascularized fibular grafting speeds up healing at the host-graft junction and thus reduces the period of immobilization needed.
