title: A modified ulnar translocation reconstruction technique for Campanacci grade 3 giant cell tumors of the distal radius using a clover leaf plate.
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.
  
  
  METHODS
  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.
  
  
  METHODS
  Between 2006 and 2013, 3 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 (TESS) for upper limb], and radiographs. The review period was 30, 51, and 41 months, respectively.
  
  
  RESULTS
  The length of distal radius resected was 70, 50, and 35 mm, respectively. All achieved clear margins. There were no complications and there have been no recurrences. All ulnocarpal translocations achieved radiographic fusion. Patient's averaged 80-degree pronation, 70-degree 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.
  
  
  METHODS
  Level III, therapeutic study.
authors.affiliation: *Division of Orthopaedics, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK †Discipline of Orthopaedics and Trauma, University of Adelaide ‡Department of Orthopaedics and Trauma, Royal Adelaide Hospital §University of Adelaide Centre for Orthopaedic and Trauma Research, Royal Adelaide Hospital, North Terrace, Adelaide, SA, Australia.
authors.forename: James M
authors.initials: JM
authors.lastname: McLean
authors.forename: Mark
authors.initials: M
authors.lastname: Clayer
authors.forename: Aaron W
authors.initials: AW
authors.lastname: Stevenson
authors.forename: Anthony J
authors.initials: AJ
authors.lastname: Samson
mesh_terms: D000328:Adult; D001859:Bone Neoplasms / Q000145:classification / Q000601:surgery*; D001860:Bone Plates; D005260:Female; D005870:Giant Cell Tumors / Q000145:classification / Q000601:surgery*; D006801:Humans; D008875:Middle Aged; D011884:Radius / Q000601:surgery*; D012189:Retrospective Studies; D014457:Ulna / Q000601:surgery*; D055815:Young Adult