Downgrading of distal radius GCT by neoadjuvant chemotherapy and arthrodesis of wrist by ulnar translocation- a case series with review of literature

Background

Distal radius giant cell tumors (GCT), Campanacci grade 3, pose a challenging problem in terms of their management and functional outcomes. Here we evaluated the effectiveness of neoadjuvant chemotherapy in downgrading the tumor combined with arthrodesis of the wrist by ulnar translocation. Neoadjuvant chemotherapy was administered to reduce tumor size and vascularity, resection was followed by arthrodesis of the wrist through ulnar translocation to stabilize the joint and restore function.

Materials and methods

A retrospective analysis was conducted on a cohort of patients with distal radius GCT who underwent this combined treatment approach. Clinical and radiographic assessments were performed preoperatively, post-chemotherapy, and at follow-up visits. Objectively, the effect of chemotherapy of tumor size was calculated and the resected length was calibrated intra-operatively. Functional outcomes were evaluated using revised MSTS score, grip strength, and functional range of motion.

Results

The study included 10 patients with a mean age of 26.6 years (18–32 years). Neoadjuvant chemotherapy resulted in a significant reduction in tumor size in all cases. The subsequent arthrodesis procedure using ulnar translocation achieved excellent stability and alignment of the wrist joint. The mean follow-up was 9.2 ± 4.21 months demonstrating reduced pain, improved grip strength of 65.77 ± 11.63 % (compared to the contralateral hand), and restored range of motion of 82.750 ± 1.440 of supination and 81.740 ± 2.340 of protonation. Of the 10 cases, one had soft tissue recurrence and one had delayed radio-ulnar union. The mean revised MSTS score was 24.9 ± 1.85 at the final follow-up.

Conclusion

Neoadjuvant chemotherapy is an effective approach for downgrading distal radius GCT and reduces the chances of recurrence. Excellent functional results are obtained from wrist reconstruction utilizing ulnar translocation, which preserves forearm and hand rotation.