title: Does Wrist Arthrodesis With Structural Iliac Crest Bone Graft After Wide Resection of Distal Radius Giant Cell Tumor Result in Satisfactory Function and Local Control?
abstract: BACKGROUND
  Many techniques have been described for reconstruction after distal radius resection for giant cell tumor with none being clearly superior. The favored technique at our institution is total wrist fusion with autogenous nonvascularized structural iliac crest bone graft because it is structurally robust, avoids the complications associated with obtaining autologous fibula graft, and is useful in areas where bone banks are not available. However, the success of arthrodesis and the functional outcomes with this approach, to our knowledge, have only been limitedly reported.
  
  
  OBJECTIVE
  (1) What is the success of union of these grafts and how long does it take? (2) How effective is the technique in achieving tumor control? (3) What complications occur with this type of arthrodesis? (4) What are the functional results of wrist arthrodesis by this technique for treating giant cell tumor of the distal radius?
  
  
  METHODS
  Between 2005 and 2013, 48 patients were treated for biopsy-confirmed Campanacci Grade III giant cell tumor of the distal radius. Of those, 39 (81% [39 of 48]) were treated with wrist arthrodesis using autogenous nonvascularized iliac crest bone graft. Of those, 27 (69% [27 of 39]) were available for followup at a minimum of 24 months (mean, 45 months; range, 24-103 months). During that period, the general indications for this approach were Campanacci Grade III and estimated resection length of 8 cm or less. Followup included clinical and radiographic assessment and functional assessment using the Disabilities of the Arm, Shoulder and Hand (DASH) score, the Musculoskeletal Tumor Society (MSTS) score, grip strength, and range of motion at every followup by the treating surgeon and his team. All functional results were from the latest followup of each patient.
  
  
  RESULTS
  Union of the distal junction occurred at a mean of 4 months (± 2 months) and union of the proximal junction occurred at a mean of 9 months (± 5 months). Accounting for competing events, at 12 months, the rate of proximal junction union was 56% (95% confidence interval [CI], 35%-72%), whereas it was 67% (95% CI, 45%-82%) at 18 months. In total, 11 of the 27 patients (41%) underwent repeat surgery on the distal radius, including eight patients (30%) who had complications and three (11%) who had local recurrence. The mean DASH score was 9 (± 7) (value range, 0-100, with lower scores representing better function), and the mean MSTS 1987 score was 29 (± 1) (value range, 0-30, with higher scores representing better function) as well as 96% (± 4%) of mean MSTS 1993 score (value range, 0%-100%, with higher scores representing better function). The mean grip strength was 51% (± 23%) of the uninvolved side, whereas the mean arc of forearm rotation was 113° (± 49°).
  
  
  CONCLUSIONS
  Reconstruction of defects after resection of giant cell tumor of the distal radius with autogenous structural iliac crest bone graft is a facile technique that can be used to achieve favorable functional results with complications and recurrences comparable to those of other reported techniques. We cannot show that this technique is superior to other options, but it seems to be a reasonable option to consider when other reconstruction options such as allografts are not available.
  
  
  METHODS
  Level IV, therapeutic study.
authors.affiliation: Department of Orthopaedic Oncology, Beijing Ji Shui Tan Hospital, Peking University, No. 31 Xin Jie Kou Dong Jie, Xi Cheng District, Beijing, 100035, P. R. China.
authors.forename: Tao
authors.initials: T
authors.lastname: Wang
authors.affiliation: Division of Orthopaedic Oncology, Department of Orthopaedics and Rehabilitation, University of Florida, Gainesville, FL, USA.
authors.forename: Chung Ming
authors.initials: CM
authors.lastname: Chan
authors.affiliation: Department of Orthopaedic Oncology, Beijing Ji Shui Tan Hospital, Peking University, No. 31 Xin Jie Kou Dong Jie, Xi Cheng District, Beijing, 100035, P. R. China.
authors.forename: Feng
authors.initials: F
authors.lastname: Yu
authors.affiliation: Department of Orthopaedic Oncology, Beijing Ji Shui Tan Hospital, Peking University, No. 31 Xin Jie Kou Dong Jie, Xi Cheng District, Beijing, 100035, P. R. China.
authors.forename: Yuan
authors.initials: Y
authors.lastname: Li
authors.affiliation: Department of Orthopaedic Oncology, Beijing Ji Shui Tan Hospital, Peking University, No. 31 Xin Jie Kou Dong Jie, Xi Cheng District, Beijing, 100035, P. R. China. niuxiaohui@263.net.
authors.forename: Xiaohui
authors.initials: X
authors.lastname: Niu
mesh_terms: D000328:Adult; D001174:Arthrodesis / Q000009:adverse effects; D001696:Biomechanical Phenomena; D001706:Biopsy; D001859:Bone Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D016025:Bone Transplantation / Q000009:adverse effects; D016208:Databases, Factual; D004185:Disability Evaluation; D005260:Female; D018212:Giant Cell Tumor of Bone / Q000000981:diagnostic imaging / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D018737:Hand Strength; D006801:Humans; D007085:Ilium / Q000637:transplantation*; D008279:Magnetic Resonance Imaging; D008297:Male; D009364:Neoplasm Recurrence, Local; D016348:Osseointegration; D010027:Osteotomy / Q000009:adverse effects; D011884:Radius / Q000000981:diagnostic imaging / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D016059:Range of Motion, Articular; D020127:Recovery of Function; D012189:Retrospective Studies; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014955:Wrist Joint / Q000000981:diagnostic imaging / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D055815:Young Adult