distal radius giant cell tumor treated …...distal radius giant cell tumor treated with excision...

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DISTAL RADIUS GIANT CELL TUMOR TREATED WITH EXCISION AND RECONSTRUCTION WITH FIBULAR AUTOGRAFT Dr. Shubhanshu Gupta Junior Resident Dept of Orthopaedics

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Page 1: DISTAL RADIUS GIANT CELL TUMOR TREATED …...DISTAL RADIUS GIANT CELL TUMOR TREATED WITH EXCISION AND RECONSTRUCTION WITH FIBULAR AUTOGRAFT Dr. Shubhanshu Gupta Junior Resident Dept

DISTAL RADIUS GIANT CELL TUMOR

TREATED WITH EXCISION AND

RECONSTRUCTION WITH FIBULAR

AUTOGRAFT

Dr. Shubhanshu Gupta

Junior Resident

Dept of Orthopaedics

Page 2: DISTAL RADIUS GIANT CELL TUMOR TREATED …...DISTAL RADIUS GIANT CELL TUMOR TREATED WITH EXCISION AND RECONSTRUCTION WITH FIBULAR AUTOGRAFT Dr. Shubhanshu Gupta Junior Resident Dept

PRESENTATION

A 65/F complaints of right wrist pain and swelling since

2 yrs.

Patient was symptomatic since 2yrs with insidious onset

pain, which was mild, dull aching, persistent and

associated with gradually progressive swelling over the

same area.

Page 3: DISTAL RADIUS GIANT CELL TUMOR TREATED …...DISTAL RADIUS GIANT CELL TUMOR TREATED WITH EXCISION AND RECONSTRUCTION WITH FIBULAR AUTOGRAFT Dr. Shubhanshu Gupta Junior Resident Dept

ON EXAMINATION OF WRIST

Swelling

over the

distal 3rd of

right

forearm

with

localized

tenderness,

bony hard

consistency

.

Page 4: DISTAL RADIUS GIANT CELL TUMOR TREATED …...DISTAL RADIUS GIANT CELL TUMOR TREATED WITH EXCISION AND RECONSTRUCTION WITH FIBULAR AUTOGRAFT Dr. Shubhanshu Gupta Junior Resident Dept

INVESTIGATION X RAY

Page 5: DISTAL RADIUS GIANT CELL TUMOR TREATED …...DISTAL RADIUS GIANT CELL TUMOR TREATED WITH EXCISION AND RECONSTRUCTION WITH FIBULAR AUTOGRAFT Dr. Shubhanshu Gupta Junior Resident Dept

COMPUTED TOMOGRAPHY

Page 6: DISTAL RADIUS GIANT CELL TUMOR TREATED …...DISTAL RADIUS GIANT CELL TUMOR TREATED WITH EXCISION AND RECONSTRUCTION WITH FIBULAR AUTOGRAFT Dr. Shubhanshu Gupta Junior Resident Dept
Page 7: DISTAL RADIUS GIANT CELL TUMOR TREATED …...DISTAL RADIUS GIANT CELL TUMOR TREATED WITH EXCISION AND RECONSTRUCTION WITH FIBULAR AUTOGRAFT Dr. Shubhanshu Gupta Junior Resident Dept

MRI

Page 8: DISTAL RADIUS GIANT CELL TUMOR TREATED …...DISTAL RADIUS GIANT CELL TUMOR TREATED WITH EXCISION AND RECONSTRUCTION WITH FIBULAR AUTOGRAFT Dr. Shubhanshu Gupta Junior Resident Dept
Page 9: DISTAL RADIUS GIANT CELL TUMOR TREATED …...DISTAL RADIUS GIANT CELL TUMOR TREATED WITH EXCISION AND RECONSTRUCTION WITH FIBULAR AUTOGRAFT Dr. Shubhanshu Gupta Junior Resident Dept

Biopsy

Page 10: DISTAL RADIUS GIANT CELL TUMOR TREATED …...DISTAL RADIUS GIANT CELL TUMOR TREATED WITH EXCISION AND RECONSTRUCTION WITH FIBULAR AUTOGRAFT Dr. Shubhanshu Gupta Junior Resident Dept

Multinucleated Giant

cell in the stroma of

mononuclear stromal

cell.

Page 11: DISTAL RADIUS GIANT CELL TUMOR TREATED …...DISTAL RADIUS GIANT CELL TUMOR TREATED WITH EXCISION AND RECONSTRUCTION WITH FIBULAR AUTOGRAFT Dr. Shubhanshu Gupta Junior Resident Dept

Biopsy S/O Giant cell

Tumor.

Page 12: DISTAL RADIUS GIANT CELL TUMOR TREATED …...DISTAL RADIUS GIANT CELL TUMOR TREATED WITH EXCISION AND RECONSTRUCTION WITH FIBULAR AUTOGRAFT Dr. Shubhanshu Gupta Junior Resident Dept

TREATMENT:

Patient planned for wide excision of the tumor

and reconstruction with ipsilateral proximal

end fibula autograft.

Page 13: DISTAL RADIUS GIANT CELL TUMOR TREATED …...DISTAL RADIUS GIANT CELL TUMOR TREATED WITH EXCISION AND RECONSTRUCTION WITH FIBULAR AUTOGRAFT Dr. Shubhanshu Gupta Junior Resident Dept

INTRA OP

Page 14: DISTAL RADIUS GIANT CELL TUMOR TREATED …...DISTAL RADIUS GIANT CELL TUMOR TREATED WITH EXCISION AND RECONSTRUCTION WITH FIBULAR AUTOGRAFT Dr. Shubhanshu Gupta Junior Resident Dept
Page 15: DISTAL RADIUS GIANT CELL TUMOR TREATED …...DISTAL RADIUS GIANT CELL TUMOR TREATED WITH EXCISION AND RECONSTRUCTION WITH FIBULAR AUTOGRAFT Dr. Shubhanshu Gupta Junior Resident Dept
Page 16: DISTAL RADIUS GIANT CELL TUMOR TREATED …...DISTAL RADIUS GIANT CELL TUMOR TREATED WITH EXCISION AND RECONSTRUCTION WITH FIBULAR AUTOGRAFT Dr. Shubhanshu Gupta Junior Resident Dept
Page 17: DISTAL RADIUS GIANT CELL TUMOR TREATED …...DISTAL RADIUS GIANT CELL TUMOR TREATED WITH EXCISION AND RECONSTRUCTION WITH FIBULAR AUTOGRAFT Dr. Shubhanshu Gupta Junior Resident Dept
Page 18: DISTAL RADIUS GIANT CELL TUMOR TREATED …...DISTAL RADIUS GIANT CELL TUMOR TREATED WITH EXCISION AND RECONSTRUCTION WITH FIBULAR AUTOGRAFT Dr. Shubhanshu Gupta Junior Resident Dept

POST OP X RAY

Page 19: DISTAL RADIUS GIANT CELL TUMOR TREATED …...DISTAL RADIUS GIANT CELL TUMOR TREATED WITH EXCISION AND RECONSTRUCTION WITH FIBULAR AUTOGRAFT Dr. Shubhanshu Gupta Junior Resident Dept

POST OP 6MONTHS FOLLOWUP

Page 20: DISTAL RADIUS GIANT CELL TUMOR TREATED …...DISTAL RADIUS GIANT CELL TUMOR TREATED WITH EXCISION AND RECONSTRUCTION WITH FIBULAR AUTOGRAFT Dr. Shubhanshu Gupta Junior Resident Dept
Page 21: DISTAL RADIUS GIANT CELL TUMOR TREATED …...DISTAL RADIUS GIANT CELL TUMOR TREATED WITH EXCISION AND RECONSTRUCTION WITH FIBULAR AUTOGRAFT Dr. Shubhanshu Gupta Junior Resident Dept
Page 22: DISTAL RADIUS GIANT CELL TUMOR TREATED …...DISTAL RADIUS GIANT CELL TUMOR TREATED WITH EXCISION AND RECONSTRUCTION WITH FIBULAR AUTOGRAFT Dr. Shubhanshu Gupta Junior Resident Dept

GCT- An Overview

Distinct neoplasm arising from non bone forming

supporting connective tissue of marrow.

Epiphyseal region (metaphyseal in immature skeleton)

20-40yrs age group.

F>M ( 1.5:1 )

5% of primary and 20% of benign bone tumor.

Solitary ,benign lesion which is locally aggressive

Distal femur>proximal tibia>distal radius

Page 23: DISTAL RADIUS GIANT CELL TUMOR TREATED …...DISTAL RADIUS GIANT CELL TUMOR TREATED WITH EXCISION AND RECONSTRUCTION WITH FIBULAR AUTOGRAFT Dr. Shubhanshu Gupta Junior Resident Dept
Page 24: DISTAL RADIUS GIANT CELL TUMOR TREATED …...DISTAL RADIUS GIANT CELL TUMOR TREATED WITH EXCISION AND RECONSTRUCTION WITH FIBULAR AUTOGRAFT Dr. Shubhanshu Gupta Junior Resident Dept

DISCUSSION High rate of local recurrence.

They should be treated more aggressively.

Grade III lesions can be treated with curettage and grafting when

the tumor does not invade the wrist, destroy less than 50% of the

cortex.

Though Functional outcome is better with curettage and bone

grafting but risk of local recurrence is high as compared with

excision and grafting.