Functional outcomes after treatment of aggressive tumors in the distal radius.
We aimed to determine whether wide excision and radiocarpal arthrodesis in patients with aggressive tumors of the distal radius resulted in more significant functional deficit than joint salvage procedures. We compared functional outcomes, surgical complications, and local tumor relapse in 33 consecutive patients. Fourteen patients initially had joint-sparing procedures, whereas 19 underwent wide resection and arthrodesis. At minimum final followup of 18 months (mean, 96 months; range, 18-204 months), local tumor relapse occurred in five of 14 patients after joint salvage versus zero of 19 after arthrodesis. Two of five patients with tumor recurrence retained their native joints, whereas three underwent resection and arthrodesis. Six of 19 patients had complications, including one nonunion, for which we performed additional surgery after arthrodesis. All patients remained disease-free at followup and none developed metastases. Disabilities of the Arm, Shoulder and Hand score, Toronto Extremity Salvage Score, and Musculoskeletal Tumor Society scores all indicated more disability after arthrodesis. Persistent pain, radiographic wrist arthritis, and weaker grip strength was seen in some patients following joint salvage. Whenever possible, joint preservation is preferable for the result of better extremity function, but weaker grip, higher local tumor relapse, and late arthritis remain concerns.
Puloski
Shannon K T
SK
The University Musculoskeletal Oncology Unit, Mt Sinai Hospital, Toronto, Ontario, Canada.
Griffin
Anthony
A
Ferguson
Peter C
PC
Bell
R S
RS
Wunder
Jay S
JS
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001174:Arthrodesis; D001859:Bone Neoplasms / Q000473:pathology / Q000601:surgery*; D002648:Child; D015331:Cohort Studies; D005260:Female; D006801:Humans; D023821:Limb Salvage / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011884:Radius; D020127:Recovery of Function / Q000502:physiology*; D012189:Retrospective Studies; D016896:Treatment Outcome; D014955:Wrist Joint