Multifocal giant cell tumor of the carpus: Unusual presentation. Case report and review of the literature

INTRODUCTION AND IMPORTANCE

Giant cell tumors (GCTs) of bone in the carpus are rare. Carpal GCTs are usually solitary lesions; multifocal involvement is exceptional. These lesions have a higher risk of local recurrence after intralesional curettage than those in other body areas.

CASE PRESENTATION

We present a case of a 28-year-old male with a six-month history of a palpable mass in the dorsal aspect of the left wrist. Physical examination revealed a 2 cm, mildly tender mass. Magnetic resonance revealed a large intermediate signal lesion involving completely hamate bone and the distal portion of the triquetrum. Histological examination confirmed a giant cell tumor of the carpus. The patient underwent en-bloc resection of the hamate bone extending to the distal part of the pyramidal. The defect was reconstructed using polymethylmethacrylate cement (PMMA), and intercarpal arthrodesis with the capitate was achieved. Follow-up at 18 months revealed a good clinical evolution, wrist range of motion of 30° of extension, 30° of flexion, and 10° of ulnar and radial deviation without evidence of tumoral recurrence.

CLINICAL DISCUSSION

The current literature suggests a high incidence of local recurrence in carpal GCT, so wide excision with carpal arthrodesis is recommended, especially in Campanacci III and multifocal involvement.

CONCLUSION

Carpal GCT is exceptional, mainly affecting the hamate, capitate, and scaphoid. Most literature supports wide excision of carpal GCT owing to the high recurrence rate with intralesional procedures.

Translation, Cultural Adaptation, and Validation of the American Orthopedic Foot and Ankle Society Scale in Patients With Hallux Valgus in Colombia

The American Orthopedic Foot and Ankle Society (AOFAS) scale for hallux metatarsophalangeal (MTP) and interphalangeal (IP) joints is used throughout the world for the clinical assessment of patients with hallux valgus, and it has 3 subscales: pain, function, and alignment. The objective of this prospective, observational study was to perform translation, cultural adaptation, and validation of this scale for Colombian Spanish. The Foot Function Index and Short Form-36 (SF-36) questionnaires were also used in the validation process. Patients who were 18 years or older, resided in the city of Bogota, were able to read and write in Spanish, and were within 4 years of corrective surgery for hallux valgus were included. A total of 79 patients were included in the study, 25 of whom were involved in the translation process and all of whom were involved in the validation process. Construct validity was demonstrated by significant positive Spearman's correlations between the AOFAS pain subscale and the AOFAS function subscale (r_s = 0.483), total AOFAS scale (r_s = 0.795), and SF-36 physical summary subscale (r_s = 0.364); and between the AOFAS function subscale and the total AOFAS scale (r_s = 0.894) and SF-36 physical summary subscale (r_s = 0.310). The test-retest process for reliability yielded intraclass correlation coefficients between the AOFAS pain, function, and alignment subscales that were all 0.70 or higher. The AOFAS scale for hallux MTP and IP joints was successfully translated and adapted into Colombian Spanish, and this version demonstrated construct validity and reliability, rendering it suitable for clinical use in Colombian patients with hallux valgus.