Giant cell tumor of bone is rare. The reported annual incidence ranges from 0.65 to 1 cases per million population and affects people between 20 and 40 years of age and is more common in women than in men [
18,
19]. Nearly 50% of the cases occur in the region of the knee. The distal radius is the third most common site for GCT, accounting for approximately 10% of cases [
18,
20,
21]. However, the location of the distal ulna is very unusual, with a reported incidence from 0.45 to 6% [
4‐
15]. When this occur, various treatment options have been proposed, including intralesional curettage, curettage and bone grafting, cryotherapy of the cavity after curettage, application of phenol after curettage, radiation, insertion of methylmetacrilate cement in the cavity after curettage, resection followed by allograft, en-bloc resection with or without reconstruction or stabilization of the ulna and prosthetic reconstruction [
22]. Of these, en-bloc resection of the distal part of the ulna maintaining extra-lesional margins with or without reconstruction or stabilization of the ulnar stump is the more oncologically advantageous treatment for GCT located in this area [
6‐
8]. According to Cooney et al. [
6], reconstruction of the osseous defect after resection of a neoplasm of the distal end of the ulna, including GCT, is usually not necessary to maintain function. Similar results were observed by Wolfe et al. [
8] in a multicenter study over wide excision of the distal ulna. However, other authors disagree because stabilization of the distal ulna following large resection, as a our case, can be a significant clinical problem with associated pain and weakness due to a decreased interosseous space with ulnar stump impingement on the radius metaphysis or instability of the radiocarpal joint with ulnar translation of the carpus [
23‐
25]. For this reason, they suggest that soft tissue stabilization of the ulnar stump should be performed whenever possible. Although an oncological prosthesis per se is currently not available to reconstruct the distal ulna following the resection of a tumor, when all of the soft tissue support is removed from the distal ulna (fundamentally, the triangular fibrocartilage complex and the interosseous membrane), the radioulnar joint prosthesis can be an option in order to replace the gross instability of the remaining ulna caused by a large segmental resection [
26]. In this sense, several prostheses have been designed for replacement of the DRUJ. However, most of them are designed to be used in patients with intact soft tissue and stabilizing ligaments at the DRUJ. These devices, therefore, are not appropriate for use in patients who have undergone resection of the DRUJ, because anteroposterior stability is not fully restored and suturing soft tissue limits mobility. However, the APTIS prosthesis can be used successfully to reconstruct and stabilize the DRUJ following the resection of a large tumor, which in this case was a giant cell tumor of the distal ulna. Moreover, the fully constrained prosthesis provided the patient the ability to return to reasonable function following the resection of a large distal segment of the ulna, although other prosthesis models have been used with good results (Table
3).
Table 3
GCT of the distal ulna treated by en-bloc resection of distal ulna and reconstruction with radioulnar joint prosthesis. A literature review
Pirela-Cruz et al. | 2008 | APTIS® | 13 m | 70 | 65 | 45 | 24 | 70 | 80 | 40 | 12.8 | E |
Roidis et al. | 2007 | E-Centrix® | 2 years | | | Full | | | | ND | ND | E |
Burke et al. | 2009 | STABILITY® | 9 m | | | Full | | | | ND | ND | E |
Gracia et al. | 2011 | APTIS® | 2 years | 80 | 70 | 35 | 15 | 80 | 80 | 44.6 | 13 | E |
Although conclusions cannot be drawn from some cases and long-term studies are required, radioulnar joint prosthesis for reconstruction after resection of a large segment of the distal ulna for GCT can be a valid option in order to reestablish the mechanical continuity of the forearm, reducing pain and improving strength and function.