Several techniques have been described to reconstruct a mobile wrist joint after resection of the distal radius for tumour. We reviewed our experience of using an osteo-articular allograft to do this in 17 patients with a mean follow-up of 58.9 months (28 to 119). The mean range of movement at the wrist was 56° flexion, 58° extension, 84° supination and 80° pronation. The mean ISOLS-MSTS score was 86% (63% to 97%) and the mean patient-rated wrist evaluation score was 16.5 (3 to 34). There was no local recurrence or distant metastases. The procedure failed in one patient with a fracture of the graft and an arthrodesis was finally required. Union was achieved at the host-graft interface in all except two cases. No patient reported more than modest non-disabling pain and six reported no pain at all. Radiographs showed early degenerative changes at the radiocarpal joint in every patient. A functional pain-free wrist can be restored with an osteo-articular allograft after resection of the distal radius for bone tumour, thereby avoiding the donor site morbidity associated with an autograft. These results may deteriorate with time

Introduction. Primary bone tumours of the distal radius are rare, while it remains the third commonest site for primary lesions and recurrences of Giant Cell Tumours (GCT). The functional demands on the hand make reconstruction of the wrist joint following the excision of distal radius, particularly challenging. Methods. A single-centre retrospective study, reporting the functional and oncological outcomes of six patients (4 males, 2 females - mean age of 53 (22 to 79)) who underwent a custom-made endoprosthetic replacement of the distal radius with arthrodesis at our institution, during 1999 - 2010. Five patients were diagnosed with primary bone sarcoma of the distal radius (4 GCTs, 1 osteosarcoma) and another had a metastatic lesion from a primary renal cell carcinoma. The diagnosis was confirmed by needle biopsy in all cases. We assessed the patients' functional outcomes using the Musculoskeletal Tumour Society scoring system (MSTS) and the Toronto Extremity Salvage Score (TESS). Results. The mean follow-up was 3 years (up to 9.5 years). One patient died of unrelated medical causes, age 89, and one patient succumbed to renal carcinoma, age 53 (9.5 and 4 years post-operatively). All prostheses remained clinically and radiologically stable. One-year radiographs confirmed bone remodelling and osseointegration at the bone-prosthesis interface. There were no cases of local recurrence, metastases, infection or wound complications post-operatively. The mean functional outcome scores were: MSTS 73% (71 to 78), TESS 75% (73 to 79). Pain-free hand movements were restored in all cases. Discussion. Reconstruction options include curettage with/without grafting or cementing, ulna translocation, autografts (vascularised or non-vascularised ⊞/⊟ arthrodesis), allografts, custom-made megaprostheses. Custom-made endoprosthetic reconstruction of the distal radius with wrist arthrodesis following bone tumour resection represents a viable and versatile treatment option. Satisfactory outcomes are achieved with acceptable risks and functional outcomes; especially when considering the nature of the diagnosis and alternative treatment options

Aims

The aim of this study was to evaluate the surgical management and outcome of patients with an acral soft-tissue sarcoma of the hand or foot.

Aims

The aims of this study were to analyse the long-term outcome of vascularised fibular graft (VFG) reconstruction after tumour resection and to evaluate the usefulness of the method.

We have investigated the oncological outcome of 63 patients with soft-tissue sarcomas of the hand managed at three major centres in the United Kingdom. There were 44 males and 19 females with a mean age of 45 years (11 to 92). The three most common diagnoses were synovial sarcoma, clear cell sarcoma and epithelioid sarcoma. Local excision was carried out in 45 patients (71%) and amputation in 18 (29%). All those treated by amputation had a wide margin of excision but this was only achieved in 58% of those treated by local excision. The risk of local recurrence was 6% in those treated by amputation compared with 42% for those who underwent attempted limb salvage. An inadequate margin of excision resulted in a 12 times greater risk of local recurrence when compared with those in whom a wide margin of excision had been achieved. We were unable to demonstrate any role for radiotherapy in decreasing the risk of local recurrence when there was an inadequate margin of excision. Patients with an inadequate margin of excision had a much higher risk of both local recurrence and metastasis than those with wide margins. The overall survival rate at five years was 87% and was related to the grade and size of the tumour and to the surgical margin.

We have shown that a clear margin of excision is essential to achieve local control of a soft-tissue sarcoma in the hand and that failure to achieve this results in a high risk of both local recurrence and metastastic disease.

We retrospectively studied local recurrence of giant cell tumour in long bones following treatment with curettage and cementing in 137 patients. The median follow-up time was 60 months (3 to 166). A total of 19 patients (14%) had at least one local recurrence, the first was diagnosed at a median of 17 months (3 to 29) after treatment of the primary tumour. There were 13 patients with a total of 15 local recurrences who were successfully treated by further curettage and cementing. Two patients with a second local recurrence were consequently treated twice. At the last follow-up, at a median of 53 months (3 to 128) after the most recent operation, all patients were free from disease and had good function.

We concluded that local recurrence of giant cell tumour after curettage and cementing in long bones can generally be successfully treated with further curettage and cementing, with only a minor risk of increased morbidity. This suggests that more extensive surgery for the primary tumour in an attempt to obtain wide margins is not the method of choice, since it leaves the patient with higher morbidity with no significant gain with respect to cure of the disease.