Giant cell tumor (GCT) of bone is a benign but locally aggressive neoplasm that predominantly affects the epiphyseal region of long bones in skeletally mature individuals. The most commonly involved sites are the distal femur, proximal tibia, and distal radius, with the distal radius accounting for approximately 10% of cases, making it the third most frequent site after the knee region1. GCT typically occurs in young adults between 20 and 40 years of age, with a peak incidence in the third decade, and shows a slight female predominance.2 Although the exact etiology of GCT remains unknown, it constitutes about 18–23% of benign bone tumors and 4–9.5% of all primary bone neoplasms3,4. Despite being classified as benign, approximately 5–10% of cases may undergo malignant transformation, which is reported to be more common in males, with a male-to-female ratio of about 3:1. In cases of malignant transformation, pulmonary metastasis can occur in nearly 5% of patients, though the prognosis is generally favorable. The biological behavior of GCT is influenced by its anatomical location, with tumors arising near the metaphyseal region of the distal radius often demonstrating more aggressive behavior5. Although classically described as an epiphyseal lesion, GCT may extend into the metaphysis and, rarely, the diaphysis, with the majority of cases showing locally aggressive characteristics. Clinically, most patients present late due to the slow-growing nature of the tumor, making management particularly challenging, especially when the lesion is close to a joint6. GCT of the distal radius poses unique therapeutic difficulties because of its proximity to the wrist joint, the complex anatomy, extensive hand movements at the wrist, and the risk of injury to adjacent neurovascular structures. Therefore, the primary goals of surgical treatment include complete excision of the tumor, preservation or restoration of maximum wrist and hand function, and prevention of local recurrence.7,8 Various treatment modalities have been described, ranging from intralesional curettage with or without cauterization—which is associated with a high local recurrence rate—to wide en bloc resection followed by reconstruction4. Reconstruction after distal radius resection remains a significant challenge, and several techniques have been employed, including non-vascularized and vascularized autogenous fibular grafts, allograft replacement, prosthetic reconstruction, and ulnar translocation with wrist arthrodesis9. Wrist arthrodesis is generally favored over wrist arthroplasty in terms of grip strength and long-term durability, whereas arthroplasty offers superior wrist mobility. AIM The present study was conducted to analyse the functional outcome of a giant cell tumor of distal end radius treated by en-bloc resection and reconstruction by ulnar translocation

This hospital-based prospective interventional study was conducted on a cohort of patients who underwent surgical treatment for a giant cell tumor of the distal end of the radius. All enrolled patients were managed with en-bloc excision of the distal radius with adequate oncological margins, followed by reconstruction using ipsilateral ulnar translocation. Only those patients with a minimum postoperative follow-up period of six months were included in the study to allow adequate assessment of functional recovery. The study was carried out in the Department of Orthopaedics, SMS Medical College and Attached Hospitals, Jaipur, Rajasthan, which is a tertiary care referral center. An additional one-month period was allotted for follow-up completion, data analysis, and thesis preparation. Adult patients with biopsy-proven giant cell tumor of the distal end of the radius who provided written informed consent were included in the study. Patients with recurrent distal radius GCT, non-salvageable tumors, or those deemed unfit for surgery were excluded. A minimum follow-up duration of six months was selected, as the study primarily focused on functional outcomes assessed through performance scores and muscle power, and this duration was considered sufficient for postoperative functional recovery.

Table-1: Frequency of distribution of age Frequency Percent < 30 years 15 60% > 30 years 10 40% In this study, the majority of patients were younger than 30 years, accounting for 60% of cases, while patients older than 30 years constituted 40% of the study population. Table 2 : Follow up in months N = 25 Mean 7.68 Minimum 6 Maximum 10 The mean value observed in the study was 7.68, with values ranging from a minimum of 6 to a maximum of 10.This indicates a relatively narrow distribution with moderate variability among the observations. Table 3: Frequency of distribution of tumor grade Frequency Percent Grade II 2 8% Grade III 23 92% Most patients in the study had Grade III lesions, accounting for 92% of cases, while only 8% presented with Grade II disease. Table 4 : Frequency of primary and redo cases Frequency Percent Revision Surgery 2 8% Primary 23 92% Primary surgery was performed in the majority of patients (92%), while revision surgery was required in only 8% of cases. Table 5:MSTS score vs Grade of tumor and Side of tumor involvement Side N Mean Std. Deviation P value MSTS score II 2 25 1 1.0000 III 23 25 2.10 MSTS score Left 13 25.15 1.83 0.7155 Right 12 24.85 2.23 The mean MSTS score in campanacci grade II tumor in 2 patients is 25 and standard deviation 1 (25 ± 1) whereas in campanacci grade III tumor in 23 patients mean 25and standard deviation 2.10 (25 ± 2.10)This association is statistically not significant with p value 1.0000 The mean MSTS score in 13 left side patients is 25.15 and Std deviation 1.83 (25.15 ± 1.83) whereas in 12 right side patients mean MSTS score 24.85 and standard deviation 2.23 (24.85 ± 2.23) found.This association is statistically not significant with p value 0.7155 Table 6: Grip strength vs Grade of tumor and Side of tumor involvement Side N Mean Std. Deviation P value Grip strength II 2 64.63 8.38 0.3031 III 23 56.93 9.98 Grip strength Left 13 57.83 6.96 0.8914 Right 12 57.29 12.12 The mean Grip strength in campanacci grade II tumor in 2 patients is 64.63 and standard deviation 8.38 (64.63 ± 8.38) whereas in campanacci grade III tumor in 23 patients mean 56.93 and standard deviation 9.98 (56.93 ± 9.98)This association is statistically not significant with p value 0.3031The mean Grip strength in 13 left side patients is 57.83 and Std deviation 6.96 (57.83± 6.96) whereas in 12 right side patients mean Grip strength 57.29 and standard deviation 12.12 (57.29 ± 12.12) found.This association is statistically not significant with p value 0.8914 Table 7: Supination movement vs Grade of tumor and Side of tumor involvement Side N Mean Std. Deviation P value Supination movement II 2 66.66 0.44 0.9123 III 23 66.17 6.10 Supination movement Left 13 67.94 4.76 0.1381 Right 12 64.34 6.85 The mean Supination movement in campanacci grade II tumor in 2 patients is 66.66 and standard deviation 0.44 (66.66 ± 0.44) whereas in campanacci grade III tumor in 23 patients mean 66.17 and standard deviation 6.10 (66.17 ± 6.10)This association is statistically not significant with p value 0.9123The mean Supination movement in 13 left side patients is 67.94 and Std deviation 4.76 (67.94 ± 4.76) whereas in 12 right side patients mean Supination movement 64.34 and standard deviation 6.85 (64.34 ± 6.85) found.This association is statistically not significant with p value 0.1381 Table 8:Pronation movement vs Grade of tumor,Side of tumor involvement Side N Mean Std. Deviation P value Pronation movement II 2 77.75 5.98 0.5860 III 23 75.35 5.86 Pronation movement Left 13 76.49 7.00 0.4133 Right 12 74.53 4.33 The mean Pronation movement in campanacci grade II tumor in 2 patients is 77.75 and standard deviation 5.98 (77.75 ± 5.98) whereas in campanacci grade III tumor in 23 patients mean 75.35 and standard deviation 5.86 (75.35 ± 5.86)This association is statistically not significant with p value 0.5860The mean Pronation movement in 13 left side patients is 76.49 and Std deviation 7.00 (76.49 ± 7.00) whereas in 12 right side patients mean Pronation movement 74.53 and standard deviation 4.33 (74.53 ± 4.33) found.This association is statistically not significant with p value 0.4133 Table 9:Recurrence vs Age and grade of tumor Age Recurrence Total P value Yes No < 30 years 1 (6.67%) 14 (93.33%) 15 (100%) 1.0000 > 30 years 0 (0%) 10 (100%) 10 (100%) Grade of tumor II 0 (0%) 2 (100%) 2 (100%) 1.0000 III 1 (4.34%) 22 (95.66%) 23 (100%) There was overall recurrence in 1 patient out of 25 patients in the age group more than 30 years. Whereas none of the patients in age group less than 30 years had recurrence. The association between age and recurrence was statistically not significant with P- value of 1.0000 by fisher's exact test. Out of 25 patients 1 case of recurrence was found in campanacci grade III tumor (4.34%) and no recurrence in grade II tumor. The association between Grade of tumor and recurrence was statistically not significant with P-value of 1.0000 by fisher's exact test.

In the present study, the majority of patients were younger than 30 years of age. A total of 15 patients, accounting for 60% of the study population, belonged to the age group below 30 years. This finding highlights the higher prevalence of the condition in younger adults. Patients older than 30 years constituted a smaller proportion of the cohort. Ten patients, representing 40% of the cases, were above 30 years of age. The mean value observed in the study was 7.68.The minimum recorded value was 6, indicating the lowest measurement in the cohort. The maximum value noted was 10,representing the highest measurement achieved. In the present study, the majority of patients presented with advanced disease.Grade III lesions constituted 92% of the cases, indicating a predominance of aggressive tumors at presentation.Only 8% of patients were classified as Grade II lesions.This skewed distribution reflects late clinical presentation in most patients.The high proportion of Grade III tumors underscores the challenging nature of management in distal radius GCT. In the present study, the majority of patients underwent primary surgery, accounting for 92% of cases.Revision surgery was required in only 8% of patients.This suggests that most cases were treated effectively during the initial surgical intervention.The low revision rate reflects appropriate case selection and adequacy of primary surgical management. In the study by Abhijeet et al10 MSTS score was more than our study may be due to longer mean follow-up (23 months) period as compared to our study mean follow-up 7.68 months. The mean MSTS score of our study 25 compared with the study by Abhijeet AS et al10 the mean MSTS score was 24 (range 22-28) In our study grip strength of affected side compared to un-affected side 57.58% is more than in study by Lackman et al (98) grip strength was 49%. It may be due to long follow-up period compared with short follow-up period mean7.68 months in our study. The supination movement 59.6º and the pronation movement 68º is more compared to the study by Minami et al11the supination 52º and the pronation movement 37º and the study by R. Saini et al12 the supination 52º and the pronation movement 37º shows that in the both study Minami et al11 and R. Saini et al12 did en-bloc excision and autograft fibula reconstruction . In above comparison ulnar-translocation provides much better forearm supination and pronation movements compared with autogenous fibula reconstruction. It is due to after ulna-translocation there is a single bone in the forearm and after fibula graft there may be synostosis which reduces supination and pronation movements. In our study union of the radius to the ulnar graft 26.08 weeks and in the study by R. Saini et al13 the average time for union at the fibula-radius junction was 33 weeks in 12 patients comparatively more. In our study the recurrence in 1 patient out of 25 patients (4%). The majority of patients were undergoing curettage and bone grafting/cementing in study by Yogesh P et al.13 Other complications in our study delayed union at the radio-ulnar junction in 3 cases (12%) and delayed union at the ulno-carpal junction in 1 case (4%). There is no non-union in our study.The non-union rate was more compared to our study in which reconstruction was done by non-vascular or vascular fibular autograft. In the study by Aithal and Bhaskaranand et al 14 reconstruction done using a non-vascular fibula autograft shows 6% non- union rates.

En-bloc excision of distal end radius giant cell tumor followed by reconstruction with ulnar translocation and wrist arthrodesis is an effective and reliable treatment modality. Ulnar translocation acts as a local vascularized bone graft, eliminating the need for microvascular surgical expertise while providing a biologically favorable environment for union. Wrist arthrodesis ensures a stable and pain-free wrist, thereby preventing instability and allowing effective hand function. This technique is associated with low infection rates and satisfactory functional outcomes, with good preservation of forearm rotation and hand movements. Tumor recurrence can be detected early with regular follow-up, and postoperative complications such as wound infection can be effectively managed with timely antibiotics and debridement when required. Joint stiffness involving the MCP, PIP, and DIP joints can be successfully addressed through regular physiotherapy and exercises.

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