55 years old, Right hand dominant lady. Presented with pain, swelling and decrease range of motion of her right wrist joint for 5 months ago.
The swelling was non tender, solitary, non fluctuant, firm at both volar and dorsal sides of distal part of her forearm about (4cm x6cm)in size with free of overlying skin and dilated veins.
There was no neurovascular deficit and hand function was normal.
The radiological finding:
X-ray revealed, aggressive, centric, expansile, well defined osteolytic lesion at epiphysis and metaphysis extending to diaphysis in the right distal area of radius, approximately measuring around 7x 4 cm ,with minimal periosteal reaction . The radiological features suggest of giant cell tumor of distal radius.
MRI scan: to assess the soft tissue involvement and medullary extension of the tumor, the scan showed distal radius articular margin involvement with aggressive soft tissue extension.
The incision biopsy, had take place longitudinally through dorsal aspect, where the definitive surgical incision had be done.
The histopathology result is Gaint cell tumor.
The Management plan: wide local resection, ulnar translocation and wrist joint arthrodesis.
Through Dorsal and longitudinal incision where was the biopsy incision done, the incision had extended proximally and distally centering over the third metacarpal bone.
The Extensor muscles reflected. level of radius resection was planned according to MRI finding including 1cm of normal healthy non-involved bone, around 8cm of distal radius was excised along with pronator quadratus through radio-carbal and radio-ulnar joint capsule .
Wide local excision of the lesion had done with normal tissue margins of bone and soft tissues.
The tumor bed treated with hydrogen peroxide 3% solution to sanitize the wound for microscopic tumor cell spillage, around 8 cm of distal ulna was resected, keeping intact all soft tissue attachments and centralized between the lunate and radius cut end , articular surfaces of distal ulna and lunate were removed with burr for arthrodesis and it was stabilized with reconstructed pre-contoured 3.5mm plate across wrist ovar the 3rd metacarpal bone.
The wound closed in layered manner over the negative suction drain to prevent hematoma formation, which is removed after 24 hours.
Above elbow slab applied for two weeks. The incision healed with primary intention and stitches were removed after two weeks.
She was advised to wear removable wrist splint and do intermittent physiotherapy, the splint was discontinued after radiological signs of union. (Figure 1)
