En bloc Excision and Matched Metatarsal Transfer for Expansive Benign Osteolytic Lesions of the Metacarpal.
OBJECTIVE
Benign aggressive expansile osteolytic lesions such as giant cell tumors and aneurysmal bone cysts involving the metacarpal head pose problems in management. Unacceptably high rates of recurrence are reported after curettage and bone grafting. An en bloc excision of such tumors ideally requires osteoarticular replacement of the excised metacarpal heads to retain mobility and function. We used nonvascularized metatarsal head and shaft harvested from the foot to replace the metacarpal defect after en bloc resection to retain movement and function of metacarpophalangeal (MCP) joint. The purpose of this study was to evaluate results of patients who underwent this procedure.


METHODS
Nine patients treated with metatarsal transfer for osteoarticular reconstruction after en bloc excision of benign aggressive osteolytic metacarpal head tumors were reviewed retrospectively. The postoperative evaluation included examination of radiographs, joint mobility, and patient rated return of function using the Michigan Hand Questionnaire.


RESULTS
Of 9 patients, 4 had aneurysmal bone cyst, 4 had giant cell tumor, and 1 an atypical cartilaginous lesion. Patients were aged between 14 and 45 years at the time of surgery. After an average of 44 months of follow-up (minimum follow-up of 24 months; range, 24-104 months), all patients had good postoperative function, satisfactory results, and no recurrence of tumor. The mean active range of motion at the reconstructed MCP joint was 75° (range, 0° to 90°). The Michigan Hand Questionnaire score averaged 80 (range, 69-92). No patient complained of donor site morbidity. One patient underwent MCP joint fusion after a pin tract infection.


CONCLUSIONS
Use of a matched metatarsal graft for osteoarticular reconstruction after en bloc excision of benign aggressive tumors involving the metacarpal head is a potential treatment option. In this limited series, consistent results with respect to functional range of motion at MCP joint, and without recurrence of tumor or notable donor site morbidity were obtained.


METHODS
Therapeutic IV.
Paul Brand Centre for Hand Surgery, Christian Medical College & Hospital, Vellore, Tamil Nadu, India.
Samuel C R
SC
Pallapati
Paul Brand Centre for Hand Surgery, Christian Medical College & Hospital, Vellore, Tamil Nadu, India. Electronic address: binu@cmcvellore.ac.in.
Binu Prathap
BP
Thomas
Paul Brand Centre for Hand Surgery, Christian Medical College & Hospital, Vellore, Tamil Nadu, India.
George A
GA
Anderson
D000293:Adolescent; D000328:Adult; D064592:Autografts; D017824:Bone Cysts, Aneurysmal / Q000000981:diagnostic imaging / Q000601:surgery*; D001859:Bone Neoplasms / Q000601:surgery*; D005260:Female; D018212:Giant Cell Tumor of Bone / Q000601:surgery*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D050279:Metacarpal Bones / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D008682:Metatarsal Bones / Q000637:transplantation*; D008875:Middle Aged; D011859:Radiography; D055815:Young Adult
Osteolytic lesion; aneurysmal bone cyst; giant cell tumor; hand tumor; matched metatarsal transfer; osteochondral reconstruction