title: [Surgical treatment for long bone giant cell tumor of extremity with pathologic fracture].
abstract: OBJECTIVE
  To identify the clinical features of patients with giant cell tumors (GCT) of long bones in extremities presented with pathological fracture (PF), and discuss the surgical strategy with retrospective analysis and literature review.
  
  
  METHODS
  We searched medical electronic records from January 1999 to December 2011 in our hospital to identify patients with definite diagnosis of extremity GCT presented with PF. Clinical data including gender, tumor site, age, surgical treatment option, postoperative complication, limb function, local recurrence and pulmonary metastasis were collected and analyzed statistically. The t-test and chi-square test were used for continuous and dichotomous variables, respectively.
  
  
  RESULTS
  Between 1999 and 2011 we treated 201 patients with GCT in extremities (long bone only: femur, tibia, fibula, humerus, ulna, and radius), 33 of whom presented with a PF. The gender ratio was 1.06 for a male predominance. The median age was 33 (15-62), and the most common site of pathologic fractures was distal femur (n=17), followed by proximal tibia (n=5), proximal femur (n=5), proximal humerus (n=4), and distal radius (n=2). Nine fractures were intra-articular. The tumors were treated by extended curettage (n=11) or en bloc excision (n=22), and the fractures were reconstructed by endoprosthesis (n=20), autologous iliums graft combined with synthetic bone substitutes (n=7), acrylic cementing (n=3), autologous fibula graft (n=2), or allograft (n=1). Ten operations were followed by complications of any kind, where implant failure and recurrence were the commonest, and re-operation rate was 27.3%. The mean functional score according to the scoring system of the Musculoskeletal Tumor Society (MSTS) was 81% in patients who received endoprosthesis replacement and 82% in other reconstruction options.
  
  
  CONCLUSIONS
  Extended curettage and en bloc resection were all considered to be the effective treatment options for patients with extremity GCT presented with PF. However, local recurrence and implant related complication were the major concern for joint reservation and prosthetic replacement, respectively.
authors.affiliation: Musculoskeletal Tumor Center, Peking University People's Hospital, Beijing 100044, China.
authors.forename: Xiao
authors.initials: X
authors.lastname: Li
authors.forename: Wei
authors.initials: W
authors.lastname: Guo
authors.forename: Yi
authors.initials: Y
authors.lastname: Yang
authors.forename: Ran
authors.initials: R
authors.lastname: Wei
authors.forename: Zhi-Ye
authors.initials: ZY
authors.lastname: DU
mesh_terms: D000293:Adolescent; D000328:Adult; D001859:Bone Neoplasms / Q000150:complications / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D003475:Curettage; D005121:Extremities; D005260:Female; D005264:Femoral Fractures / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery; D005500:Follow-Up Studies; D005598:Fractures, Spontaneous / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D018212:Giant Cell Tumor of Bone / Q000150:complications / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D006801:Humans; D006810:Humeral Fractures / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery; D057072:Intra-Articular Fractures / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D011885:Radius Fractures / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery; D012189:Retrospective Studies; D013978:Tibial Fractures / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D055815:Young Adult