Optimizing Functional Recovery in Multi-Site Giant Cell Tumors.

Introduction: Giant cell tumor (GCT) in Orthopedics is a clinically challenging problem pertaining aggressive expansion and recurrence. While GCT's typically occur at epiphyseal ends of long bones, unusual locations, such as tendon sheath, distal ulna, and proximal tibia have been reported, which impose different challenges for management.

Case series: In this case series, we present surgical methodology tailored for individual characteristics of GCTs, with emphasis on functional recovery. We demonstrate four cases involving different sites GCT - tendon sheath in hand, distal ulna, distal radius, and proximal tibia. Each case was managed using a site-specific surgical approach, ranging from en bloc resection with ulna transposition and arthrodesis to Illizarov assisted bone transport. Emphasis is laid on strategic surgical technique coupled with functional preservation and prevention of recurrence. All patients were successfully treated without recurrences at follow-up ranging 6 months to 2 years. Functional outcomes varied depending on the location and extent of surgical dissection, but improved overall, as evident by patients' return to routine daily activities with significant relief from pain. This case series underscores importance of a tailored, site-specific approach for managing GCT.

Conclusion: Strategic surgical intervention employed with limb-sparing technique using reconstructive surgery, highlights the potential for restoration of optimal function while minimizing the risk of recurrence. However, the diversity of GCT presentation necessitates vigilant surveillance and an individualized patient management plan.