April, 2014
A modified ulnar translocation reconstruction technique for Campanacci grade 3 giant cell tumors of the distal radius using a clover leaf plate
McLean JM, Clayer M, Stevenson AW, Samson A.
Techniques in Hand & Upper Extremity; Tech Hand Up Extrem Surg. 2014 Sep;18(3):135-42.
ABSTRACT
Background: Campanacci grade 3 giant cell tumors of the distal radius are locally aggressive and in close proximity to the median nerve; articular cartilage; flexor and extensor tendons; and the radial artery. Although several reconstructive techniques have been described, it is unclear to what degree these procedures restore function.
Description of technique: We present a modified ipsilateral ulna translocation technique using a clover leaf plate, for reconstruction of en bloc resected distal radius. This has the theoretical advantage of ensuring a solid, pain-free wrist arthrodesis, while preserving the forearm rotational axis and minimizing functional loss; without the associated donor site morbidity or allograft rejection issues of other reconstructive techniques.
Patients and Methods: Between 2006 and 2013, three patients underwent this procedure for Campanacci grade 3 giant cell tumors. All patients were right-hand dominant females, aged 24, 35 and 46 years respectively. Two cases involved the right radius. Patients were reviewed retrospectively with clinical examination, functional assessment (the Toronto Extremity Salvage Score for upper limb) and radiographs. The review period was 30, 51 and 41 months respectively.
Results: The length of distal radius resected was 70mm, 50mm and 35mm respectively. All achieved clear margins. There were no complications and there have been no recurrences. All ulno-carpal translocations achieved radiographic fusion. Patient’s averaged 800 pronation, 700 supination and clinical TESS scores of 86 at most recent follow-up.
Conclusions: This technique achieved a painless and functional wrist arthrodesis with partially restored wrist motion, without complications. This technique has the advantage of negating remote donor site morbidity and/or allograft rejection issues of other techniques.
Level of evidence: Level III, therapeutic study.