Thanapon Chobpenthai1, Pichaya Thanindratarn2, Termphong Phorkhar3, Thammasin Ingviya4. 1. Faculty of Medicine and Public Health, HRH Princess Chulabhorn College of Medical Science, Chulabhorn Royal Academy, Bangkok, Thailand; Department of orthopedics, Chulabhorn Hospital, Bangkok, Thailand. Electronic address: thanapon.cho@pccms.ac.th. 2. Department of orthopedics, Chulabhorn Hospital, Bangkok, Thailand. Electronic address: pichaya.tha@pccms.ac.th. 3. Department of orthopedics, Chulabhorn Hospital, Bangkok, Thailand. Electronic address: termphong.pho@pccms.ac.th. 4. Department of family Medicine and Preventive Medicine, Prince of Songkhla University, Thailand. Electronic address: thammasin@yahoo.com.
Abstract
BACKGROUND: En-bloc resection of giant cell tumors (GCTs) of the distal radius remains the mainstay treatment for those with high-graded lesions. Several techniques have been described for reconstruction of the resected segment, of which transposition of the ipsilateral ulna is scarcely reported. OBJECTIVES: To investigate the efficacy and safety of the different techniques of ulnar translocation following GCTs total resection. METHODS: A systematic review and meta-analysis was conducted concerning the reported functional outcomes, including grip strength, range of forearm motion, functional scores, and new bone formation, as well as postoperative complications, such as delayed union, local recurrence and metastasis. The ranges of functional outcomes were reviewed and the pooled prevalence rates of complication and their respective 95% confidence intervals (95% CIs) were computed. RESULTS: In a total of 12 studies, 90 patients (51.1% males, 84.8% had Campanacci grade III tumors) underwent five different reconstruction techniques. As compared to the normal side, the mean grip strength in the affected side ranged between 59 and 71%. The average union time was 1-8 months, while delayed union was reported in 50% (95% CI, 15.35 to 84.65) of patients whom their grafts were fixed with Steinmann pins. The shortest union time, the highest forearm supination and pronation degrees, new bone formation at the ulnar stump, and the highest functional scores were reported following a modified distal radius plate technique. Using a dynamic compression plate and a clover leaf plate provided lower, but considerable, functional outcomes. CONCLUSION: Ulnar translocation following GCT en-bloc resection warrants additional investigation in large cohorts and well-designed studies to corroborate the promising outcomes presented in this review.
BACKGROUND: En-bloc resection of giant cell tumors (GCTs) of the distal radius remains the mainstay treatment for those with high-graded lesions. Several techniques have been described for reconstruction of the resected segment, of which transposition of the ipsilateral ulna is scarcely reported. OBJECTIVES: To investigate the efficacy and safety of the different techniques of ulnar translocation following GCTs total resection. METHODS: A systematic review and meta-analysis was conducted concerning the reported functional outcomes, including grip strength, range of forearm motion, functional scores, and new bone formation, as well as postoperative complications, such as delayed union, local recurrence and metastasis. The ranges of functional outcomes were reviewed and the pooled prevalence rates of complication and their respective 95% confidence intervals (95% CIs) were computed. RESULTS: In a total of 12 studies, 90 patients (51.1% males, 84.8% had Campanacci grade III tumors) underwent five different reconstruction techniques. As compared to the normal side, the mean grip strength in the affected side ranged between 59 and 71%. The average union time was 1-8 months, while delayed union was reported in 50% (95% CI, 15.35 to 84.65) of patients whom their grafts were fixed with Steinmann pins. The shortest union time, the highest forearm supination and pronation degrees, new bone formation at the ulnar stump, and the highest functional scores were reported following a modified distal radius plate technique. Using a dynamic compression plate and a clover leaf plate provided lower, but considerable, functional outcomes. CONCLUSION: Ulnar translocation following GCT en-bloc resection warrants additional investigation in large cohorts and well-designed studies to corroborate the promising outcomes presented in this review.