Osteoid osteoma of the distal radius presenting as an inconspicuous swelling in a young child.

Osteoid osteoma is a benign osteoblastic tumour with a predilection for the lower extremity that rarely affects the forearm. It is commonly seen in adolescents and young adults, and is seldom diagnosed in the paediatric age group. We report a boy in his early childhood who presented with a swelling over the distal forearm, which was incidentally noted by the mother 3 months ago. Plain radiographs showed diffuse sclerosis of the dorsal cortex of the distal radius. CT scan showed a central lucent nidus in the intramedullary region and surrounding sclerosis in the radial metaphysis, confirming the diagnosis of osteoid osteoma. The patient was successfully treated by surgical en bloc resection of the nidus and was asymptomatic at 1-year follow-up. Non-specific symptoms at presentation make it a challenge to diagnose osteoid osteoma in children and it needs to be considered in the differential diagnosis when radiographs show lytic lesions in the bone.

Performance Prediction for Surgical Outcomes in Laparoscopic Partial Nephrectomy Using Nephrometry Scores: A Comparison of Zhongshan and Radius, Exophytic/Endophytic, Nearness, Anterior/Posterior, Location Systems.

Objective: The aim of this study is to compare the precision and applicability of the Zhongshan (ZS) score against the radius, exophytic/endophytic, nearness, anterior/posterior, and location (RENAL) score in forecasting perioperative outcomes during laparoscopic partial nephrectomy (LPN). Materials and Methods: We retrospectively analyzed data from 99 renal cancer patients who underwent LPN between January 2017 and August 2023. Patients were scored and categorized based on both the ZS and RENAL scores. The study then compared perioperative outcomes across these groups and further investigated the correlation between ZS and RENAL scores and overall complication rates. Results: LPN was successfully accomplished in 94 patients, whereas 5 patients necessitated conversion to open or radical surgery. The high-risk group, according to the ZS score, manifested more warm ischemic time (WIT) than the low-risk group (P = .007). Furthermore, the incidence of overall complications escalated with increase in the ZS score grade (P = .045). A higher RENAL score corresponded to a greater risk of conversion to open or radical treatment (P = .012). Correlation analyses revealed associations between both ZS and RENAL scores and overall complications. The RENAL score also correlated with changes in blood creatinine values, while the ZS score was associated with WIT (all P < .05). In the univariate analysis, both ZS and RENAL scores were substantial factors for the occurrence of total complications (P = .029 and P = .027, respectively), but they were not statistically significant in the multivariate analysis. The receiver operating characteristic curves suggested that both individual and combined ZS and RENAL scores held predictive potential for the onset of overall complications (area under the curve = 0.652, 0.660, and 0.676, respectively). Conclusions: Compared with the RENAL score, the ZS score provides a more comprehensive assessment of tumor complexity in patients undergoing LPN. Integrating these two scores could potentially improve the accuracy of predicting surgical risks.

Autogenous fibula head transplantation for aneurysmal bone cyst of distal radius: A case report followed up for 7 years.

RATIONALE: Aneurysmal bone cyst (ABC) is a rare primary or secondary tumor that usually occurs in young women aged between 10 and 20 years, mostly in the long tubular bone and spine. However, there are no definite standards for its clinical treatment. To our knowledge, this is the first report of a young female patient with distal radius ABC who was successfully treated with tumor resection and autogenous fibular head transplantation. PATIENT CONCERNS: A 28-year-old married Chinese young woman presented to our hospital with swelling and pain in her right wrist for 2 years and aggravation of wrist movement restriction for 1 week. DIAGNOSES: Pathological biopsy confirmed ABC. INTERVENTIONS: We performed a pathological examination of the tumor on the right wrist and preliminarily confirmed the diagnosis of ABC. The right wrist joint was reconstructed by total surgical resection of the ABC tumor in the right wrist joint and autogenous fibular head transplantation. OUTCOMES: During follow-up within 7 years, good right wrist function was confirmed. The tumor did not recur, the swelling of the right wrist disappeared, the joint pain and limitation of movement significantly improved, and the function of the right wrist was not impaired in daily activities. Radiography showed that the fracture had healed. LESSONS: Our results suggest that autofibular head transplantation is an effective treatment for reconstruction of wrist function in adult patients with ABC of the distal radius.

Pre-operative bone quality deficits and risk of complications following spine fusion surgery among postmenopausal women.

Poor bone quality is a risk factor for complications after spinal fusion surgery. This study investigated pre-operative bone quality in postmenopausal women undergoing spine fusion and found that those with small bones, thinner cortices and surgeries involving more vertebral levels were at highest risk for complications. PURPOSE: Spinal fusion is one of the most common surgeries performed worldwide. While skeletal complications are common, underlying skeletal deficits are often missed by pre-operative DXA due to artifact from spinal pathology. This prospective cohort study investigated pre-operative bone quality using high resolution peripheral CT (HRpQCT) and its relation to post-operative outcomes in postmenopausal women, a population that may be at particular risk for skeletal complications. We hypothesized that women with low volumetric BMD (vBMD) and abnormal microarchitecture would have higher rates of post-operative complications. METHODS: Pre-operative imaging included areal BMD (aBMD) by DXA, cortical and trabecular vBMD and microarchitecture of the radius and tibia by high resolution peripheral CT. Intra-operative bone quality was subjectively graded based on resistance to pedicle screw insertion. Post-operative complications were assessed by radiographs and CTs. RESULTS: Among 50 women enrolled (age 65 years), mean spine aBMD was normal and 35% had osteoporosis by DXA at any site. Low aBMD and vBMD were associated with "poor" subjective intra-operative quality. Skeletal complications occurred in 46% over a median follow-up of 15 months. In Cox proportional models, complications were associated with greater number of surgical levels (HR 1.19 95% CI 1.06-1.34), smaller tibia total area (HR 1.67 95% CI1.16-2.44) and lower tibial cortical thickness (HR 1.35 95% CI 1.05-1.75; model p < 0.01). CONCLUSION: Women with smaller bones, thinner cortices and procedures involving a greater number of vertebrae were at highest risk for post-operative complications, providing insights into surgical and skeletal risk factors for complications in this population.

Pediatric parosteal osteosarcoma of the distal radius causing extensive erosive mass effect of the adjacent ulna: a case report.

INTRODUCTION: Parosteal osteosarcomas are low-grade bony malignancies that are treated primarily with surgical resection and reconstruction. This report discusses a unique case of a pediatric patient who presented with a parosteal osteosarcoma of the distal radius causing extensive erosive mass effect and growth disturbance of the adjacent ulna. Likely due to their slow-growing nonaggressive nature, parosteal osteosarcomas have not been previously described to abut adjacent bony structures through direct contact. The patient presented in a significantly delayed manner due to social circumstances, inadvertently revealing this novel behavior. This report reviews this rare case and describes the current understanding of this tumor. CASE PRESENTATION: The patient is a 13-year-old male who presented with a parosteal osteosarcoma of his distal radius. He presented with a palpable wrist mass and wrist stiffness. He presented in a delayed manner with advanced local disease due to social factors. Imaging revealed an osseous radial mass that abutted the ulna and likely stunted its growth. The patient ultimately underwent complex resection and allograft reconstruction of both his distal radius and ulna. Intraoperative pathology was confirmed to have negative tumor margins. Allograft reconstruction of the radius and ulna was performed utilizing patient-specific custom cutting guides. At the 6-month postoperative visit, the patient had no recurrence of the mass, minimal pain, and had almost regained range of motion of the extremities. Clinical radiographs at the 6-month postoperative visit demonstrated allograft incorporation. CONCLUSIONS: A previously unreported case of pediatric parosteal osteosarcoma of the distal radius with erosion of the adjacent ulna through direct contact is presented. The challenges in and the importance of arriving at a definitive diagnosis in a timely manner for the proper treatment of this malignancy are emphasized.

Extensor carpi ulnaris tendon pathology and ulnar styloid bone marrow edema as diagnostic markers of peripheral triangular fibrocartilage complex tears on wrist MRI: a case-control study.

OBJECTIVES: To evaluate extensor carpi ulnaris (ECU) tendon pathology and ulnar styloid process bone marrow edema (BME) as diagnostic MRI markers for peripheral triangular fibrocartilage complex (TFCC) tears. METHODS: One hundred thirty-three patients (age range 21-75, 68 females) with wrist 1.5-T MRI and arthroscopy were included in this retrospective case-control study. The presence of TFCC tears (no tear, central perforation, or peripheral tear), ECU pathology (tenosynovitis, tendinosis, tear or subluxation), and BME at the ulnar styloid process were determined on MRI and correlated with arthroscopy. Cross-tabulation with chi-square tests, binary logistic regression with odds ratios (OR), and sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were used to describe diagnostic efficacy. RESULTS: On arthroscopy, 46 cases with no TFCC tear, 34 cases with central perforations, and 53 cases with peripheral TFCC tears were identified. ECU pathology was seen in 19.6% (9/46) of patients with no TFCC tears, in 11.8% (4/34) with central perforations and in 84.9% (45/53) with peripheral TFCC tears (p < 0.001); the respective numbers for BME were 21.7% (10/46), 23.5% (8/34), and 88.7% (47/53) (p < 0.001). Binary regression analysis showed additional value from ECU pathology and BME in predicting peripheral TFCC tears. The combined approach with direct MRI evaluation and both ECU pathology and BME yielded a 100% positive predictive value for peripheral TFCC tear as compared to 89% with direct evaluation alone. CONCLUSIONS: ECU pathology and ulnar styloid BME are highly associated with peripheral TFCC tears and can be used as secondary signs to diagnose tears. KEY POINTS: • ECU pathology and ulnar styloid BME are highly associated with peripheral TFCC tears and can be used as secondary signs to confirm the presence of TFCC tears. • If there is a peripheral TFCC tear on direct MRI evaluation and in addition both ECU pathology and BME on MRI, the positive predictive value is 100% that there will be a tear on arthroscopy compared to 89% with direct evaluation alone. • If there is no peripheral TFCC tear on direct evaluation and neither ECU pathology nor BME on MRI, the negative predictive value is 98% that there will be no tear on arthroscopy compared to 94% with direct evaluation alone.

Retained cartilaginous core in the distal radius of a small breed dog.

A 5-month-old castrated male Smooth Fox Terrier presented for a 1-month history of right thoracic limb lameness. Physical examination revealed right elbow pain on extension and mild soft tissue swelling of the distal antebrachium. Radiographs and computed tomography showed elongated focal radiolucent regions in the distal radial metaphysis. There was incongruity of the right elbow with a short radius. Bone biopsy and histopathology of the regions confirmed a retained cartilaginous core characterised by bony trabeculae with frequently retained central cartilaginous cores. A dynamic proximal ulnar ostectomy was performed to improve elbow congruity. The owner was instructed to restrict activity to short leash walks for 8 weeks followed by a gradual activity increase. On follow-up examination 16 weeks after operatively, the lameness and elbow pain were resolved. Radiographs at that time showed a healed ulnar ostectomy, proper elbow congruity, and resolved retained cartilaginous core.

Facet Inclinations and Interfacet Angle of the Distal Radius on Posteroanterior Radiographs: Clinical Associations With 3 Carpal Pathologies.

PURPOSE: The radiographic interfacet angle (IFA), scaphoid facet inclination (SFI), and lunate facet inclination (LFI) of the distal radius were measured in patients with 3 distinct wrist pathologies to determine whether there is an association between these radiographic measurements and these conditions. METHODS: Posteroanterior wrist radiographs were compiled from patients with 3 types of common wrist pathologies (scaphoid waist fracture [n = 54], scapholunate [SL] dissociation [n = 23], and dorsal ganglion [n = 51]). The patients were all Caucasians aged 20 to 45 years who met strict radiographic criteria. The IFA, SFI, and LFI values of these patients were compared with those obtained from 400 normal wrist radiographs of subjects who met the same selection criteria. RESULTS: In men with a scaphoid waist fracture, the IFA and SFI were significantly greater than in normal men, whereas the LFI was significantly lower. In the SL dissociation group, for all patients and for subgroups stratified according to sex, the IFA and SFI were significantly lower than in the normal matched groups. In the dorsal ganglion group, differences were found in the IFA and SFI for women, but not for men. CONCLUSIONS: The facet orientations of the distal radius in patients with scaphoid fracture, SL dissociation, and dorsal ganglion differed from those in the normal population. The IFA alone is most likely to be associated with all 3 pathologies. The SFI and LFI are less likely to be associated with patients with carpal pathologies. CLINICAL RELEVANCE: Patients with a greater IFA may be susceptible to scaphoid fractures when they fall on an overstretched hand. Patients with a smaller IFA may be susceptible to SL dissociation when they fall on an overstretched hand.

Angular limb deformities due to distal radial physeal osteochondrosis in farmed deer stags in New Zealand.

CASE HISTORY: Three different farms reported cases of angular limb deformities (ALD) in rising 2-year-old velvet, mostly red deer (Cervus elaphus), stags with the earliest recorded cases occurring in 2010. Farm 1 reported a prevalence of 10-35%, farm 2, 5-11.5%, and farm 3, 2-5%. Farms 1, 2, and 3 are located in South Canterbury, northern Southland, and the Waikato, respectively. CLINICAL FINDINGS: Affected animals developed ALD, with predominantly varus forelimb (bowed) deformities. On all farms serum calcium and phosphorus concentrations in affected animals were normal. Serum and liver copper concentrations were variable across the period of the study and between farms. Although some measurements were below the reference ranges, there was no evidence for a statistical association with the prevalence of abnormalities. PATHOLOGICAL FINDINGS: The distal radius from 25 affected and four control red and red-wapiti (Cervus canadensis) cross deer from Farm 1 in 2010/2011, two affected red deer from Farm 2 in 2016, and one affected red deer from Farm 3 in 2021, were examined. The most consistent lesions were present in the distal radial physis, most commonly the lateral edge. There was mild-to-severe segmental thickening of the physis and, in some animals, physeal cartilage was duplicated with both sections of physis varying in thickness. Microscopically, in severely affected animals there was massive segmental thickening of physeal cartilage which often contained large cystic cavities. The cartilage matrix was eosinophilic and showed a loss of metachromatic staining with toluidine blue. In less severe cases, necrotic physeal vessels were present, consistent with vascular failure. In more chronic cases, there was duplication of the physis, the two layers being separated by a combination of normal trabecular bone and dense fibrous connective tissue. DIAGNOSIS: Physeal osteochondrosis. CLINICAL RELEVANCE: Osteochondrosis has a multifactorial aetiology and we propose that an increased requirement for nutrients for velvet production and increased weight-bearing stress (behaviour and rapid weight gain) may lead to progression of osteochondrosis and ALD in these deer. The involvement of periods of copper deficiency is unclear at this time.

Vascularized Medial Femoral Condyle Periosteal Flaps With Allograft Bone for Distal Radius Giant Cell Tumors: A Case Report.

CASE: Distal radius reconstruction after giant cell tumor (GCT) resection is typically performed with free fibular flaps when a vascularized bone is needed. However, vascularized fibular flaps are contraindicated in patients with peroneal artery variants. We present 2 patients with GCTs of the radius and bilateral peronea arteria magna who underwent resection with wrist fusion using an allograft bone and vascularized free medial femoral condyle periosteal flaps. Both patients had excellent outcomes with minimal postoperative morbidity. CONCLUSION: Allograft bone with vascularized medial femoral condyle periosteal flaps is an effective option for reconstructing distal radius defects after GCT resection when conventional methods fail.

Outcomes of distal radial endoprostheses for tumour reconstruction: a single centre experience over 15 years.

We report a retrospective study over a 15-year period, between 2005 and 2020, evaluating clinical and functional outcomes in patients who underwent reconstruction of the distal radius with an endoprosthetic replacement following excision of both malignant and aggressive benign bone tumours. Data was collected retrospectively from a prospectively maintained electronic database, and prospectively via telephone patient consultation. Musculoskeletal Tumour Society and patient-rated wrist evaluation scores were assessed at a minimum of 1 year postoperatively. Of nine implants, five were arthrodeses and four were arthroplasties. One patient required amputation within 6 months for proximal metastatic disease. At last follow-up, eight patients subjectively reported good function. Five patients returned to high functionally demanding jobs. Mean Musculoskeletal Tumour Society and patient-rated wrist evaluation scores were 72% and 50/100, respectively. We conclude that distal radius endoprosthetic replacements offer acceptable functional outcomes and remain a viable option when biological reconstruction is not possible.Level of evidence: IV.

[Application of LARS ligament combined with three-dimensional printed prosthesis in reconstruction of radial hemicarpal joint after tumor resection].

Objective: To investigate the effectiveness of LARS ligament and three-dimensional (3D) printed prosthesis on the combined reconstruction of radial hemicarpal joint after distal radius tumor resection. Methods: The clinical data of 12 patients with combined reconstruction of radial hemicarpal joint with LARS ligament and 3D printed prosthesis after distal radius tumor resection between September 2017 and March 2021 were retrospectively analyzed. There were 7 males and 5 females with an average age of 41.8 years (range, 19-63 years). There were 8 cases on the left side and 4 cases on the right side, and 10 cases of giant cell tumor of bone and 2 cases of osteosarcoma. The disease duration ranged from 1 to 20 months, with an average of 8.1 months. The osteotomy length, operation time, and intraoperative blood loss were recorded, and the wrist function was evaluated by Mayo wrist score and Musculoskeletal Tumor Society (MSTS) score before and after operation. The grip strength of the affected limb was expressed by the percentage of grip strength of the healthy upper limb, and the range of motion (ROM) of the wrist joint was measured, including extension, flexion, radial deviation, and ulnar deviation; the bone ingrowth and osseointegration at the bone-prosthesis interface of the wrist joint were observed by radiographic follow-up; the possible wrist complications were recorded. Results: All 12 patients successfully completed the operation. The osteotomy length was 5.0-10.5 cm (mean, 6.8 cm), and the operation time was 180-250 minutes (mean, 213.8 minutes). The intraoperative blood loss was 30-150 mL (mean, 61.7 mL). All patients were followed up 11-52 months (mean, 30.8 months). Radiographic follow-up showed that bone ingrowth and osseointegration at the bone-prosthesis interface were observed in all patients, and biological fixation was gradually achieved. During the follow-up, the stability, motor function, and ROM of the wrist joint were good. There was no complication such as arthritis, subluxation, prosthesis loosening, and infection, and no tumor recurrence and metastasis. At last follow-up, the Mayo score was 82.1±5.4, and MSTS score was 27.5±1.5, which were significantly improved when compared with those before operation (48.8±13.5, 16.4±1.4; t=-10.761, P<0.001; t=-26.600, P<0.001). The grip strength of the affected side was 59%-88% of that of the healthy side, with an average of 70.5%. The ROM of wrist joint were 55°-80° (mean, 65.42°) in extension, 35°-60° (mean, 44.58°) in flexion, 10°-25° (mean, 17.92°) in radial deviation, 10°-25° (mean, 18.33°) in ulnar deviation. Conclusion: The combined application of LARS ligament and 3D printed prosthesis is an effective way to reconstruct bone and joint defects after distal radius tumor resection. It can improve the function of wrist joint, reduce the incidence of complications, and improve the stability of wrist joint.

Wide resection for giant-cell tumor of the distal radius: which reconstruction? A systematic review of the literature and pooled analysis of 176 cases.

Giant-cell tumor (GCT) is often more aggressive when located in the distal radius, and wide resection is then the gold-standard. No single reconstruction protocol is recommended, and the technique depends upon the surgeon's preferences. The aim of the present review was to determine the recurrence rate of GTC of the distal radius after intralesional treatment, to assess the results, advantages and complications of the various surgical techniques, and to draw up a decision-tree for surgical indications. The review of literature was performed in the main healthcare databases, searching for studies that reported results of wide resection and reconstruction of distal radius GCT. Local recurrence rates, metastasis rates, reconstruction techniques and respective results and complications were evaluated and analyzed. Sixteen studies were selected, for a total population of 226 patients; 6.0% and 0.9% experienced local recurrence and lung metastasis, respectively. Arthroplasty with non-vascularized or vascularized ipsilateral fibula were the most common techniques and were associated with the highest satisfaction rates: 86.4% and 88.0%, respectively. Arthroplasty with allograft presented a MusculoSkeletal Tumor Society (MSTS) score of 79.2% and arthroplasty with custom-made prosthesis presented an MSTS score of 81.8%. Arthrodesis was performed in 46 cases, with an MSTS score of 82.7%. Arthroplasty techniques are the most common in literature; they are used in patients who wish to conserve joint motion. Reconstruction with non-vascularized fibula seems to provide the best results, with lower morbidity. Arthrodesis is usually reserved for heavy manual workers or in case of arthroplasty failure.

Treatment of giant cell tumors of the distal radius: A long-term patient-reported outcomes study.

INTRODUCTION: The distal radius is a common location for giant cell tumors (GCTs) of bone. Management includes intralesional curettage or wide excision, however, long-term comparisons of treatment options are limited. The purpose of the current study was to evaluate our institutions' outcomes of treatment of these tumors. METHODS: We reviewed 24 GCT of the distal radius in 23 patients (12 males: 11 females) with a mean age of 42 years at the time of surgery. Functional outcomes were collected including the Musculoskeletal Tumor Society Score (MSTS), QuickDash, the Visual Analog Scale (VAS), and the Patient Rated Wrist Evaluation (PRWE). The mean follow-up was 13 years. RESULTS: Tumor grade included Campanacci Grade II (n = 14) and Grade III (n = 10). Treatment included extended intralesional curettage (n = 16) and wide excision (n = 8). Reconstruction mainly included bone grafting/cement (n = 16) or free vascularized fibula radiocarpal arthrodesis (n = 5). At most recent follow-up, there was no difference in MSTS, VAS, and PRWE (p > 0.05) between patients undergoing a joint sparing or arthrodesis. Patients undergoing arthrodesis had a lower QuickDASH score (13.7 vs. 20.8, p = 0.04) CONCLUSIONS: Treatment for GCT of the distal radius is individualized however in the setting of articular surface involvement, arthrodesis can lead to superior functional results at long-term follow-up.

Parosteal lipoma of the radius with posterior interosseous nerve palsy.

Parosteal lipoma is a rare benign soft tissue mesenchymal tumour that may impair limb motor function when located adjacent to neurovascular structures. We report a case of a woman in her 80s with a long-standing lesion in the forearm and consequent sensory and motor function changes. She was admitted for an elective excision of the lipoma. Postoperative evolution was favourable, with marked improvement of limb function. Our aim in sharing this case is to create awareness of these rare deep-seated lipomas that might originate nerve palsy and should therefore be excised as soon as possible to avoid neurological damage.

Diaphyseal giant cell tumor with multiple relapses in a skeletally immature patient: a case report.

Giant cell tumor (GCT) is an aggressive osteolytic lesion mostly affecting the meta-epiphyses of long bones at skeletal maturity. Occurrence of the GCT in diaphysis is a rare entity in adult and exceptionally rare in pediatric population. This is the only third diaphyseal case reported in pediatric population. We report a case of recurrent diaphyseal GCT in a skeletally immature patient of 15-year-old male at the right radius after previous resection with plate and screw fixation. Upon optimal investigations, en-bloc resection of the tumor with radial resection and ulna centralization with wrist arthrodesis was done for a campanacci stage III GCT. The patient had an uneventful recovery without recurrence for 2 years and 2 months following surgery. The main challenge relies on accurate diagnosis due to uncommon location that hinders adequate treatment plan, therefore diagnosis should be solely based on histopathology findings.

En bloc resection and vascularized ulnar pedicle graft reconstruction with plate fixation for giant cell tumour of the distal radius.

We retrospectively reviewed the medical records of ten patients (five men and five women) who were treated in our unit for Campanacci Grade III giant cell tumour of the distal radius between July 2017 and December 2019. Following en bloc resection of a giant cell tumour of the distal radius, the wrist was reconstructed by transposing a vascularized pedicle graft from the ipsilateral ulnar shaft. The graft was fixed to the radial shaft and proximal carpal row with plates. At a mean follow-up of 23.5 months (range 18 to 31), bony union was achieved in all cases and there were no tumour recurrences. All patients had a good range of pronation and supination, but flexion and extension of the wrist was limited. DASH scores ranged from 5 to 11. This reconstruction method is a safe and effective procedure that provides good aesthetic outcomes, removes the need for microvascular techniques and reduces donor site morbidity.Level of evidence: IV.

Wrist Reconstruction Using Free Vascularized Fibular Head Graft Following Intralesional Excision for Campanacci Grade 3 Giant Cell Tumors Involving the Articular Surface of the Distal Radius.

Reconstruction with a free vascularized fibular head graft after en bloc excision of a Campanacci grade 3 giant cell tumor of bone in the distal radius can effectively control local recurrence. However, it leads to the loss of wrist movement, subsequent radiocarpal subluxation, and an osteoarthritic change. Another treatment option for grade 3 lesions is intralesional excision and cementation, which preserves wrist movement but does not restore the articular surface. We report a case of wrist reconstruction using a free vascularized fibular head graft after the intralesional excision of a Campanacci grade 3 giant cell tumor of bone with invasion of the articular surface of the distal radius. In patients with this type of a lesion, wrist reconstruction using a free vascularized fibular head graft after intralesional excision can help prevent local tumor recurrence, restore the articular surface, and maintain movements of the wrist joint.

Bone Impairment in a Large Cohort of Chinese Patients With Tumor-Induced Osteomalacia Assessed by HR-pQCT and TBS.

Tumor-induced osteomalacia (TIO) is a rare paraneoplastic syndrome caused by excessive production of fibroblast growth factor 23 (FGF23) by a tumor. Previous studies have revealed generalized mineralization defects and low areal bone mineral density (aBMD) in TIO. However, data on the bone microarchitecture in TIO are limited. In this study, we evaluated the microarchitecture in the peripheral (distal radius and tibia) and axial (lumbar spine) skeleton using high-resolution peripheral quantitative computed tomography (HR-pQCT) and trabecular bone score (TBS) and investigated related factors in a large cohort of Chinese patients with TIO. A total of 186 patients with TIO who had undergone dual-energy X-ray absorptiometry (DXA) or HR-pQCT scans were enrolled. Compared with age-, sex-, and body mass index (BMI)-matched healthy controls, TIO patients (n = 113) had lower volumetric BMD, damaged microstructure, and reduced bone strength in the peripheral skeleton, especially at the tibia. The average TBS obtained from 173 patients was 1.15 ± 0.16. The proportion of patients with abnormal TBS (<1.35) was higher than that with low L1 to L4 aBMD Z-score (Z ≤ -2) (43.9% versus 89.6%, p < 0.001). Higher intact fibroblast growth factor 23 (iFGF23), intact parathyroid hormone (iPTH), alkaline phosphatase, and ß-isomerized C-terminal telopeptide of type I collagen (ß-CTx) levels, more severe mobility impairment, and a history of fracture were associated with poorer HR-pQCT parameters but not with lower TBS. However, greater height loss and longer disease duration were correlated with worse HR-pQCT parameters and TBS. Moreover, TBS was correlated with both trabecular and cortical HR-pQCT parameters in TIO. In conclusion, we revealed impaired bone microarchitecture in the axial and peripheral skeleton in a large cohort of Chinese TIO patients. HR-pQCT parameters and TBS showed promising advantages over aBMD for assessing bone impairment in patients with TIO. A longer follow-up period is needed to observe changes in bone microarchitecture after tumor resection. © 2021 American Society for Bone and Mineral Research (ASBMR).

Reconstruction of the distal radius using a double-barrel vascularized fibula flap: A case series.

Treatment of distal radius tumor sometimes requires sacrificing the epiphysis. We propose adding to currently available reconstruction options a technique using a double-barrel vascularized fibula flap fixed distally to the first carpal row, conserving midcarpal mobility. We monitored 4 cases of Campanacci III giant-cell tumor and 2 cases of osteosarcoma. After en-bloc tumor resection, a double-barrel vascularized fibula flap was lodged distally in the scaphoid and lunate and proximally in the radius. Follow-up was clinical and radiological, using DASH, PRWE and MSTS functional scores. At a median 3 years' follow-up, there were no cases of recurrence or non-union. Median ranges of motion were 23° flexion, 28° extension, 90° pronation and 62° supination. Median grip strength proportional to the contralateral side was 67%. Median DASH and PRWE functional scores were respectively 13.7 and 17 points. Median MSTS was 83%. Although this technique is challenging, with difficulties in double-barrel flap placement and in pedicle plication, the double-barrel vascularized fibula flap provided a stable and mobile wrist.