Cases reported "Giant Cell Tumor of Bone"

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1/10. Vascularized fibular graft after excision of giant cell tumor of the distal radius. A case report.

    Although hemiarthroplasty of the wrist using vascularized proximal fibula has been described often, long term results with documentation of results are insufficient. A case of giant cell tumor of the distal radius with remarkable extraskeletal extension is reported. Vascularized fibula including its proximal head was used to replace the defect created after en bloc resection of the tumor. There was no deterioration in radiographic findings or function of the new joint at the time of the 10-year followup. Satisfactory range of motion of the wrist and the forearm was maintained. There was no instability in the joint, and grip strength measured 65% of the opposite side. Postoperative magnetic resonance imaging showed survival of the whole graft, including the subchondral portion. In addition to thorough revascularization of the graft, appropriate soft tissue reconstruction using dynamic tendon transfer contributed to the success. When these requirements are fulfilled, the graft can provide a functional and durable result. Although this is a single experience, the authors recommend wrist arthroplasty, rather than arthrodesis, in carefully selected patients.
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2/10. Upper limb salvage with microvascular bone transfer for major long-bone segmental tumor resections.

    A series of 14 young, active patients who underwent vascularized bone graft reconstructions of large (9-15 cm) segmental skeletal defects of the upper extremity resulting from resection of a variety of bony tumors is presented. Eight defects involved the proximal humerus and required shoulder joint reconstruction, two were mid humeral and four involved the distal radius. Surgical techniques for both distal radius reconstruction with vascularized iliac crest and vascularized fibular head and glenohumeral reconstruction using the vascularized fibula are described. Several cases are discussed in detail, including achievement of bony union, postoperative range of motion and pain, and each patient's ability to resume activities. The literature is reviewed, and other reconstructive options for large bony defects of the upper extremity after tumor resection are discussed: nonvascularized bone grafts, allograft transfer, and custom prosthetic devices. The authors think that vascularized bone grafting offers the most favorable method of upper extremity salvage with preservation of joint function, especially at the shoulder.
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3/10. A case report: reconstruction of a damaged knee following treatment of giant cell tumor of the proximal tibia with cryosurgery and cementation.

    OBJECTIVE: Reconstruction of a knee damaged by cement packed to cure a giant-cell tumor is sometimes difficult. We reconstructed such a knee by removal of the cement, autologous bone transplantation and distraction osteogenesis using the Ilizarov apparatus. In this paper the results 29 months after the salvage surgery are given. PATIENT AND methods: We saw a 31-year-old woman's knee joint that showed osteoarthritic change after curettage, cryosurgery and cementation performed 4 years previously for a giant-cell tumor of the proximal tibia. We reconstructed the knee joint. This procedure included cement removal, alignment correction by tibial osteotomy, subchondral bone reconstruction by autologous bone transplantation, and filling the defect after removing the bone cement by elongating the diaphysis using the Ilizarov apparatus. RESULTS: Distraction was terminated 4 months later when 54 mm of elongation was performed. All devices were removed 12 months after the surgery. Seventeen months after the removal of the apparatus, the range of motion of the right knee was 0 degrees extension and 110 degrees flexion, and the patient was able to walk without pain. CONCLUSIONS: Although the treatment period is long and there may be some complications of Ilizarov lengthening and distraction osteogenesis, this procedure has numerous benefits. Bony defects can be soundly reconstructed and, at the same time, the alignment of the knee can be corrected. Also it is not necessary to reconstruct the ligaments because the insertions are intact. If osteoarthritis progresses, a surface type total knee replacement can be performed, not constrained type prosthesis, which would be used if the bony structure had not been reconstructed. This procedure may be one of the candidates for reconstructing such knee joints destroyed by bone cement.
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4/10. Vascularized fibular graft after excision of giant-cell tumor of the distal radius: wrist arthroplasty versus partial wrist arthrodesis.

    Several reconstructive procedures have been described for the complete defect of the distal radius that is created after a wide excision of a giant-cell tumor of bone, including hemiarthroplasty using the vascularized fibular head and partial wrist arthrodesis between a vascularized fibula and the scapholunate portion of the proximal carpal row. The objectives of this study are to compare clinical and radiographic results between the partial wrist arthrodesis and the wrist arthroplasty, and to discuss which procedure is superior. Four patients with giant-cell tumors involving the distal end of the radius were treated with en bloc resection and reconstruction with a free vascularized fibular graft. The wrists in two patients were reconstructed with an articular fibular head graft and the remaining two patients underwent partial wrist arthrodesis using a fibular shaft transfer. There was radiographic evidence of bone union at the host-graft junctions in all cases. In the newly reconstructed wrist joint, there was palmar subluxation of the carpal bones and degenerative changes in both patients. Local recurrence was seen in one patient. According to the functional results described by Enneking et al., the mean functional score was 67 percent. The functional scores including wrist/forearm range of motion in the cases with partial wrist arthrodesis were superior to those with wrist arthroplasty. A partial wrist arthrodesis using a vascularized fibular shaft graft appears a more useful and reliable procedure for reconstruction of the wrist after excision of the giant-cell tumor of the distal end of the radius than a wrist arthroplasty using the vascularized fibular head, although our study includes only a small number of patients.
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5/10. Dedifferentiated chondrosarcoma with a noncartilaginous component mimicking a conventional giant cell tumor of bone.

    We report a case of dedifferentiated chondrosarcoma in which the dedifferentiated component of the tumor shows a close histologic resemblance to a conventional giant cell tumor of bone. The tumor affected a 30-year-old woman with a long history of left shoulder discomfort and limitation of motion. Radiographic studies revealed a biphasic destructive lesion in the left proximal humerus composed of high-signal lobulated component on T2-weighted magnetic resonance image accompanied by a low signal intensity component exhibiting destructive growth with extension into soft tissue. Microscopically, two different areas consisting of the chondroid tissue and nonchondroid giant cell-rich lesion resembling conventional giant cell tumor of bone were found. Considering that the prognosis and survival associated with these two entities are very different, it is important to be aware of this variant of dedifferentiated chondrosarcoma to avoid the misdiagnosis of conventional giant cell tumor of bone.
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6/10. Fibulo-scapho-lunate arthrodesis as a motion-preserving procedure after tumour resection of the distal radius.

    Free microvascular fibula transfer is an established method for reconstruction of the distal radius following tumour resection. If the radial articular surface is resected, fixation of the fibula to the carpus is either performed as a complete wrist fusion, or the fibular head is transferred together with the shaft to replace the radial joint surface, thus allowing some wrist mobility but providing only limited wrist stability. Fibulo-scapho-lunate fusion represents an alternative. This reconstruction in two patients provided excellent wrist stability and a functional range of midcarpal motion.
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7/10. Microsurgical fibular graft for full-length radius reconstruction after giant-cell tumor resection: a case report.

    In this article, we present the treatment of a recurrent giant-cell tumor of the radius with en bloc resection and full-length radius reconstruction with a 24-cm long microsurgical fibular graft. At time of 8-year follow-up, there was no evidence of tumor recurrence. A satisfactory range of motion of the elbow, wrist, and forearm was maintained. There was no instability in the joints, and grip strength measured 63% of the opposite side. With appropriate dynamic tendon transfer, this procedure can provide an alternative method for reconstruction of the full-length radius after tumor resection, with functional and durable results.
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8/10. Central column reconstruction following total resection of a third metacarpal giant cell tumour.

    A wide resection of a giant cell tumour involving the entire middle metacarpal is presented. Reconstruction preserving the central column and metacarpophalangeal joint was achieved using autologous iliac crest bone as a spacer and structural support. The fibro-osseous cartilage portion of the iliac graft was used as a "hemi-joint" replacement. By using a bridging bone graft and screw to fuse the adjacent proximal phalanges of the middle and index fingers, a stable "internal syndactyly" was achieved. Although independent index and middle finger motion was sacrificed, the approach allowed wide resection for local tumour control, re-established structural integrity, preserved metacarpophalangeal joint motion and allowed early motion. The aesthetic result was also good.
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9/10. Craniofacial treatment of giant-cell tumors of the sphenoid bone.

    We report a craniofacial approach for resection of a giant-cell tumor of the sphenoid bone. Complementary radiotherapy was performed because of the incomplete tumor remotion. Four-year follow-up is presented.
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10/10. Ulnar buttress arthroplasty for reconstruction after resection of the distal ulna for giant cell tumour.

    A giant cell tumour of the distal end of the ulna was treated by en bloc resection. The resected distal end of the ulna was replaced by an iliac bone graft, preserving the triangular fibrocartilage complex. The wrist was pain-free and had a full range of motion 6 months postoperatively.
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