Third-Ray and Capitate Resection with Limited Midcarpal Fusion for Recurrent Giant Cell Tumor: A Case Report

Tricortical Bone Grafting with Limited Midcarpal and Carpometacarpal Fusion for the Treatment of Giant Cell Tumor of the Capitate

Background  Giant cell tumor (GCT) of capitate is a rare lesion that is challenging to treat. Case Description  We present a case of a 12-year-old girl suffering from a GCT of the capitate. Wide excision combined with adjuvant treatment including hydrogen peroxide, alcohol, tricortical bone grafting, and limited midcarpal and carpometacarpal fusion achieved good functional result without evidence of tumor recurrence or radiocarpal degeneration at 8 years postoperatively. Clinical Relevance  In this case with long-term follow-up, surgical treatment of capitate GCT with limited midcarpal and carpometacarpal fusion led to a satisfactory outcome despite the alteration of wrist kinematics.

Mammoth Giant Cell Tumor of the First Metacarpal: A Case Report and Management Trends

Giant cell tumor (GCT) is classically described as a locally aggressive, epiphyseo-metaphyseal osteolytic tumor occurring in young adults. They are mostly seen in long bones while some are also found in the iliac bone and spine and a very small proportion occurs in hand bones. Due to the rarity of GCT in metacarpal, there is a paucity of treatment options available. In an extensive literature search on PubMed, Embase, Medline, and Ovid from 2004 till date, very few cases were reported.

The various treatment options available are intralesional curettage with or without adjuvant therapy, wide resection, free osteoarticular metatarsal transfer, and, occasionally, ray amputation may also be done. After simple curettage, a reasonably high recurrence rate also imposes comprehensive en-bloc excision, but still, there are many case reports of recurrence.

Experience with a case of GCT of the whole first metacarpal extending from the carpometacarpal to the metacarpophalangeal joint is not thoroughly described in the literature. We hereby report a mammoth GCT of the first metacarpal treated by excision and reconstruction by free fibular graft and adjacent joint fusion with an excellent functional outcome at one-year follow-up.