Long-term follow-up after en bloc resection of the distal radius with reconstruction using ulnar translocation

Le résumé fourni par la source

Reconstruction of the distal radius after en bloc bone tumor resection is challenging. Among various surgical reconstruction methods, ulnar translocation is a simple approach that does not require vascular anastomosis, autograft harvesting, or prosthesis preparation. This report describes the 7-year follow-up of a patient who underwent reconstruction with ulnar translocation following resection of a recurrent giant cell tumor of the bone. A 57-year-old woman was diagnosed with multiple recurrent giant cell tumor of the bone involving the distal radius. The patient underwent en bloc resection of the tumor with osteotomy of the distal radius 5 cm proximal to the wrist joint through a dorsal incision. The distal ulna was osteotomized at the same level and translocated with preservation of the vascularity of the posterior interosseous artery. Then, the translocated ulna was fixed to the carpal bone and distal radius and aligned in the mid-supination and pronation positions; fixation at 10° of wrist dorsiflexion was performed using locking plates. Bone union between the metacarpal bone, grafted bone and proximal radius was achieved at 9 months postoperatively. At the 1-year follow-up examination, the range of motion of the wrist was 90°/65° (supination/pronation), and the grip strength was 9.1 kg. At the final follow-up examination (7 years postoperatively), the range of motion of the wrist was 90°/90° (supination/pronation) and the grip strength was 19 kg (20 kg on the lateral side). The patient's QuickDASH and Hand 20 scores were 25 and 43, respectively, indicating minor difficulties in daily activities. Ulnar translocation is regarded as a practical alternative to more complex reconstructive procedures for the distal radius following en bloc tumor resection. Its benefits include surgical simplicity, long-term durability, and preservation of forearm rotation.

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