Reconstruction with fibular autograft and silicone implant arthroplasty after resection of giant-cell tumour of the proximal phalanx: a case report with 18-month follow-up

Metacarpophalangeal joint reconstruction using a costal osteochondral graft: A case report

RATIONALE

The conventional treatment of giant cell tumors is intralesional curettage with local adjuvant therapy. Because hand tumors have a high local recurrence, the primary goal for treating tumors of the hand is to eradicate the lesion.

PATIENT CONCERNS

To preserve the metacarpophalangeal (MCP) joint function as well as avoid further recurrence after surgery.

DIAGNOSES

The giant cell tumor invades the patient's MCP joint in an index proximal phalanx.

INTERVENTIONS

Using computer-aided design and three-dimensional printing techniques, we reformed the original shapes of the MCP joint and its peripheral bone to replica models. The surgeon then performed an en bloc resection and proximal phalanx with MCP joint reconstruction by fabricating the patient's costal osteochondral graft during the operation.

OUTCOMES

After 6 months of rehabilitation, the patient's finger functions could pinch and grasp objects naturally. At the 1-year follow-up, the range of motion of the MCP, proximal interphalangeal, and distal interphalangeal joints improved from flexion of 35° to 60°, 75° to 85°, and 60° to 80°, respectively. The hand function achieved the mean performance of non-preferred hands for young females at the postoperative 3-year follow-up.

LESSONS

The customized prototyping technique has the potential to replica the original patient's bony graft to reach the goal of minimizing the defects at the donor site and maximizing the function of the reconstructed MCP joint.

A management strategy for giant cell tumor of the metacarpal: A single-center series of 11 cases

BACKGROUND

Primary giant cell tumor (GCT) arising from bones of hand are rare to occur. Metacarpals are often the most common site of involvement among hand bones. There are no uniform guidelines for treatment of GCT involving metacarpals due to lack of relevant literature.

OBJECTIVE

To suggest a management strategy for GCT involving metacarpals.

METHODS

Retrospective review of cases of GCT involving metacarpals over a period of 15 years from 2005 to 2019 managed at department of Orthopaedics, All India Institute of Medical Sciences, New Delhi.

RESULTS

A total of 12 cases of GCT involving metacarpal were included, out of which one was lost to follow-up. Four cases were recurrent, and seven were primary at the time of surgery. All the patients were operated with wide excision of the tumor. In seven patients reconstruction of the metacarpal and MCPJ was done using fibular strut graft and silastic artificial joint, while in two patients, MCPJ arthrodesis was performed using fibula and/or iliac crest bone graft. In another two patients, the MCPJ was reconstructed using reversed vascularised toe transfer. Mean follow up of the patients was 3.22 ± 2.07 years. Mean Quick DASH score at latest follow-up of patients operated with silastic joint reconstruction, reversed vascularised toe transfer and arthrodesis of MCP joints were 30.5 ± 9.5, 25 ± 2.3 and 39.8 ± 3.4 respectively. Local recurrence occurred only in one patient at one year after surgery. All the patients were pain free at latest follow-up with quite functional and cosmetically acceptable hand.

CONCLUSION

Reversed vascularised metatarsal transfer has obtained better functional results compared to reconstruction with fibular grafting and silicone joint replacement but due to technical difficulties, vascularised joint transfer may not be performed in every setting and there is risk of donor site morbidities with this technique. Our strategy for the treatment of GCT involving metacarpal was to do vascularised joint transfer or arthrodesis for border digits and reconstruction with silicone joint for central digits.

Osteoid osteoma of the phalanx and metacarpal bone: report of 17 cases

BACKGROUND

Osteoid osteoma (OO) is a slowly progressing benign osteoblastic tumour. In the hand, this tumour is rare. We propose a review of seventeen cases of OO of the phalanx and metacarpal bone.

PATIENTS AND METHODS

During the period, between 1998 and 2011, a total of seventeen OO in the hand were confirmed by the pathological examination. They were 10 women and 7 men with an average age of 29 years (age range 17-76). The most common site of the tumour was the proximal phalanx in ten cases, followed by middle phalanx in four cases and metacarpal bone in three cases. The diagnosis of OO was highly required by clinical history. Standard radiographs showed variable images, but computed tomography, and it was useful to facilitate diagnosis and pre-operative planning. All patients underwent surgery (the tumour resection and autogenous bone grafting). In post-operative, there was an immediate pain relief with complete resolution of all symptoms. No recurrence was observed during the last follow-up period of 4 years and 2 months.

CONCLUSION

The diagnosis of OO of the hand can be difficult, and it should be considered with bony pain or bony swelling, especially when the history is a chronic one. The CT scan allows visualisation and precise localisation of such benign tumour of the hand. The care should be taken to make the excision complete in order to avoid recurrence.