Custom-made wrist prosthesis in a patient with giant cell tumor of the distal radius
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HANDSURGERY
Custom-made wrist prosthesis in a patient with giant cell tumor of the distal radius Hans-Georg Damert • Silke Altmann Armin Kraus
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Received: 28 April 2012 / Published online: 10 March 2013 Ó Springer-Verlag Berlin Heidelberg 2013
Abstract Introduction Treatment for giant cell tumors of the distal radius is challenging when motion is to be preserved. As standard wrist prostheses typically do not achieve favorable results, we treated a 36-year-old man with giant cell tumor of the distal radius with a new, custom-made implant. Methods A custom-made wrist prosthesis with a long shaft was designed according to the patient’s X-ray findings. After complete tumor resection, the prosthesis was subsequently implanted into the distal radius without complications. Results Two months after surgery, range of motion was 30°-0-25° for extension/flexion, 10°-0-5° for ulnar/radial abduction, 80°-0-0 for pronation/supination, complete range of motion for the fingers, and a grip strength of 6 kg. Two years after surgery, implant position was still correct and range of motion was 45°-0-10° for extension/flexion, 10°-0-20° for ulnar/radial abduction, and 80°-0-10° for pronation/supination. Grip strength was 16 kg, and DASH score was 25 compared to 39 before surgery. The patient returned to work as a craftsman. Conclusion Custom-made wrist prostheses could become a practical option in patients with large defects of the distal radius who desire to preserve wrist motion. Keywords Wrist Prosthesis Implant Custom-made Giant cell Tumor
H.-G. Damert S. Altmann A. Kraus (&) Department of Plastic, Aesthetic and Hand Surgery, Otto-von-Guericke University, Leipziger Strasse 44, 39120 Magdeburg, Germany e-mail: [email protected]
Introduction Treatment for giant cell tumors (GCTs) of the distal radius is challenging when motion is to be preserved. GCTs are known to cause destruction of the distal radius with disruption of the joint surface. They often develop at the epiphyseal growth zone of long bones and also around joints or inside joints themselves. These tumors are most prevalent at the femur, the proximal tibia, feet, and fingers of adolescents or young adults. They seldom occur before the fifteenth year of age. It is a rare entity with an incidence of 2 in 10 million inhabitants [1]. Clinically, they present as pain, swelling and impaired motion, and sometimes by pathologic fracture. GCTs originate from undifferentiated mesenchymal cells of the bone marrow, and their incidence is high in the third decade of life [2, 3]. Distant metastasis is rare, but growth may be locally destructive. According to Campancci’s classification, three stages can be distinguished: stage 1 with an asymptomatic, intracompartmental tumor; stage 2 with a symptomatic, intracompartmental tumor causing cortical thinning; and stage 3 with an extracompartmental tumor invading the adjacent soft tissue [4]. Clinical symptoms are often unspecific such as radiating pain and swelling. In conventional X-ray, GCTs usually appear as osteolytic
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