A giant cell tumor of the bone is rare, benign and locally aggressive tumor, setup 4% to 5% of all primary bone tumors and 18% to 20% of all benign bone tumors. There are two variants known – the primary malignant giant cell tumor that was found in up to 10% of cases and the rare sarcomatous proliferation, that appears inside the lesion A slight majority of the cases are appear in females.
In this article, we will present you a five years study case of surgery procedures, including the follow ups, on a giant cell tumor of the capitate bone of a 51 years old female patient. There were different outcomes on each follow up year, which were made out of her condition, but they ended up better than everyone could ever think of.
Img. 1. Preoperative diagnosis findings
The first x-ray made to this patient showed a intraosseous lytic lesion on the right capitate bone (img.1), associated to a bone-granulocyte scintigraphy and the -x-ray showed low to intermediate signal intensity of the lesion without soft-tissue extension. Along with this finding, the radiologist suggested a osteomyelitis. A first sample was taken and in the histological examination was revealed a benign giant cell tumor. It had to be performed an interlesional curettage and packing the cavity with cancellous iliac crest bone with a fusion of the third carpometacarpal joint using a titanium plate.
Img. 2. Results from 1 year after the first surgery
After one year, the lateral radiographies taken, showed that the union of the carpometacarpal joint fusion was a success, but there was a destruction of the proximal pole of the reconstructed capitate bone at the distal facet of lunate bone. The third carpometacarpal joint plate fusion had to be removed and this time the histological examination did not show a giant cell tumor but revealed a midcarpal osteoarthritis. In the course of the surgery, a nonunion at the waist of scaphoid bone was seen. A CT scan showed a complete union of the third carpometacarpal joint fusion associated with an appropriate osseointegration of cancellous bone grafts at the capitate bone, along with a humpback deformity due to a nonunion to the waist of the scaphoid bone (img. 2).
Img. 3. 4th surgery procedures and results
They had to perform a cutting of the entire scaphoid bone using a corticocancellous iliac crest bone graft and two cannulated headless titanium compression screws (img.3).
One year after, the longitudinally inserted compression screw was transferred into the radiocarpal joint with erosion of the articular surface at the distal radius. The patient declined a total wrist fusion, so the surgery team had to perform a total wrist arthroplasty, which ended up being a great solution and the course ended up being simple.
On the next 3 years follow up, the x-rays taken did not showed any signs of a giant cell tumor, impingement or instability with terminal ranges of motion (img. 4).
Img. 4. 3 years-follow up results
Some of the results related to the patient’s pain reduced from 8 to 2 (0 to 10 scale) and the wrist evaluation improved from 88 to 37 (0 to 100 scale). The wrist extension and wrist ulnar deviation improved from 20° to 45° and from 20° to 30°. The wrist flexion and wrist radial deviation remained the same as the preoperative situation (img. 5).
Img. 5. Final results
The treatment for the giant cell tumors had amazing improvements over the years, giving the patients different surgical options.
Nowadays, the Maestro total wrist designed by Biomet is giving the greatest outcomes for your patient’s condition, such as in this specific study case. The design of the implant allows the excision of the entire scaphoid bone, so it is not always necessary to attempt fusion of the distal pole of the scaphoid to the surrounding carpal bones.
As a doctor, this is an example of what you can do in this type of situations. PeekMed can help you to plan this type of surgeries and predict the outcomes so you and your team can be confident.