Publication: Comparative study of clinical outcomes of vascularised versus non-vascularised fibular graft reconstruction after wide resection of giant cell tumour of distal radius
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Date
2021
Authors
Hwee, Teo Geok
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Abstract
Introduction Giant cell tumour (GCT) of distal radius is a benign tumour but can be locally aggressive. The tumour can be devastating to the bone which may result in severe deformity. For Campanacci grade III and some grade II usually treated by wide local excision followed by reconstruction using either autologous vascularised or non-vascularised fibular graft and both were reported with good results. We would like to compare the clinical outcomes of these two groups of treatment. Materials and methods This is a multicentre cross sectional study involving Hospital Universiti Sains Malaysia (HUSM) and University Malaya Medical Centre (UMMC). Patients who diagnosed with distal radius GCT and underwent wide resection followed by reconstruction with either autologous vascularised fibular graft (VFG) or non-vascularised fibular graft (NVFG) between year 2000 and 2019 in respective centres with minimum 1 year of follow up were included. Indications for VFG are Campanacci grade III, extensive soft tissue involvement, large tumour and fracture deformity. A total of 21 patients (7 VFG and 14 NVFG) fulfilled the criteria with a median age of 27 years were called for assessment using musculoskeletal tumour society (MSTS) score. Among the 21 patients, 9 males (5 VFG, 4 NVFG) and 12 females (2 VFG, 10 NVFG). Bony union was determined by plain radiograph with bridging callus at least three cortices in two views. Non-parametric Mann-Whitney U test were used for statistical analysis using SPSS version 24. Results The Overall MSTS score of NVFG was 80%, better than VFG 73.3% but statistically was not significant with the p-value of 0.60. In comparison of each component in MSTS scoring found to be no significant difference in pain (p = 0.48), function (p = 0.94), emotional (p = 0.50), hand positioning (p = 0.61), manual dexterity (p = 0.93) and lifting ability (p = 0.89). Median difference of union rate for VFG was 30 weeks (IQR = 31) while NVFG was 22.8 weeks (IQR = 23). There was no significant difference in union rate (p = 0.52) between these two groups of patients. However, two patients from NVFG group were reported non-union whereas all patients in VFG group achieved union. No serious morbidity reported at donor site from both groups. Conclusion Generally, VFG patients have larger tumour, hence more complicated surgeries. However clinical outcomes are generally similar compared to NVFG. VFG has slightly higher complication rates but they are considered minor whereas NVFG has serious complications such as non-union and graft resorption which required revision surgery. This is a retrospective study with limited sample size. Prospective study with larger sample size is justified to further prove these results
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Keywords
Giant cell tumour of bone , distal radius