One stage custom made 3D vascularized bone reconstruction by free fibula transfert for large radiocarpal defect after wide gigantic cell tumor resection.

Abstract

Introduction: Bone gigantic cell tumours (BGCTs) are locally aggressive benign tumours, which can lead to significant functional impairment due to extensive bone destruction and soft tissue invasion and typically occur in the meta-epiphyseal region of long bones with the distal radius being the third most common site. Advanced BGCTs of the wrist present a significant challenge for the medical staff due to their occurrence in subarticular bone. Bone reconstruction of the hand with 3D assisted engineering has been described with promising results. In this article, we present a novel approach for bone reconstruction of a large radiocarpal defect following wide giant cell tumour resection, utilising a free transfer of a two-strut fibula with the aid of a 3D surgical planning.

Results: Patient reports no chronic pain with a DASH score of 20/100. The patient is stable with a grip strength of 26kg in the left hand and 40kg in the right hand. At 6 months, range of motion was 30° extension and 0° flexion, 80° pronation and 60° supination. Consolidation was successfully achieved with no bone resorption.

Discussion: Distal radius BGCTs present a complex therapeutic dilemma, necessitating strategies that balance oncologic control with functional preservation. Tumour removal is mainly achieved by curettage or wide en bloc resection. Bone reconstruction can be achieved through autologous bone grafting, autologous bone transfer, or arthroplasty. Numerous studies have reported good to excellent outcomes for wrist arthroplasty; however, this reconstruction technique carries risks. Wrist arthrodesis tends to achieve better results as it can restore better grip strength. Excellent functional and radiological outcomes were observed for malignant tumours of the distal radius treated with fibulo-scapho-lunate arthrodesis. Custom surgery assisted by 3D surgical planning improves postoperative outcomes and reduces complication rates especially for bone reconstruction. A detailed custom 3D surgical plan was developed prior to surgery using a two-strut free fibula transfer. Stable fixation was achieved with a custom-made titanium plate anchored on the radius and first carpal row, perfectly matching the bone transfer and recipient site. This technique achieved full bone consolidation at 6 months with margin free tumour resection and acceptable wrist range of motion. The patient is pain free and has return to his daily activity in 6 weeks after surgery.

Conclusion: This article showcases the successful use of a two strutted fibular free transfer for bone reconstruction to reconstruct a large distal radius defect following BGCT excision with the support of 3D surgical planning.