Several Considerations in Free Vascularized Fibular Head Grafting for Giant Cell Tumor of Distal Radius

Treatment of giant cell tumor of distal radius can be treated in several ways according to the aggressiveness of the tumor. The management of giant cell tumor involving subchondral bone of the distal radius has always been a difficult problem and whether preserving joint function should be considered. In these circumstances, wrist arthroplasty using free vascularized fibular head grafting can be considered as one of available options to preserve the wrist joint motion. However, the reports for final outcomes of wrist arthroplasty using vascularized fibular head have been variable and there have been several debates about its techniques. The purpose of this article is to discuss the several considerations in wrist arthroplasty using free vascularized fubular head graft for giant cell tumors of the distal radius.

Total Wrist Arthroplasty (Three Cases Report) / 대한정형외과학회잡지

We have performed three total wrist arthroplasty of Meuli type on the dominant wrist of three female patients who have been suffering from the classical rheumatoid arthritis for more than two years, and after follow them for average twenty months postoperatively, we have found, even the complications and reoperation rate after total wrist arthroplasty are reported high in literature, three patients have reasonably satisfied with the remarkable relief of pain and the functional abilities of their wrists. It is our belief, even if the total wrist arthroplasty is also still in controversy, that in those patients with bilateral wrist involvement by the rheumatoid arthritis in whom arthrodesis was done on one wrist, then a total wrist arthroplasty on dominant wrist is a most prefer way to reconstruct the disabled wrists.

Surgical Treatment in Rheumatoid Wrist / 대한정형외과학회잡지

The authors have analysed 39 rheumatoid wrists in 25 rheumatoid patients, who underwent vsrious surgeries including arthroscopic and open synovectomy, partial and total arthrodesis and total wrist arthroplasty at the department of orthopaedic surgery, St. Mary's Hospital from November 1985 to April 1988, and the effect of eaeh surgery on the wrist function and proper time of operation are discussed. The results were as follows; 1. The patients who were classified as a classical rheumatoid arthritis according to the ARA criteria were four males and twenty-one females, with a mean age of 43 yesrs, and the functional capacity of the patients before operation was graded in III for twenty-threeand in IV for two patients. 2. Out of 25 patients (39 wrists), 14 patients are in bilateral and II patients in unilateral involvement. The synovectomy in 13 wrists, arthrodesis in 24 wrists and total joint replacement in 2 wrists were performed and followed them for average 17 months after operation. 3. The synovectomy were done for 13 wrists in grade II and III according to the classification of rheumstoid arthritis by radiology(3). There were two cases of recurrence in the cases of synovectomy, but not in replacement and arthrodesis. 4. The arthrodesis of wrist was performed for 24 wrists-bilateral arthrodesis in 3 patient (6 wrists) and unilateral fusion in 18 patients. For 4 cases out of 24 cases of wrist arthrodesis, the second and third carpo-metacsrpal joints were fused simultaneously. 5. Protek total wrist arthroplasty was done in 2 cases snd followed them for more than9 months with relatively good clinical results. Finally, it is our beliefs for rheumatoid wrists that surgery is often indicated to control the various wrist problems, early synovectomy is strongly indicated, and partial wrist fusion has proven to be effective in patients with moderate destruction, deformity and pain, but the total wrist arthrodesis and arthroplasty is still in controversy. The proper surgery for rheumatoid wrist should be determined by the clinical severity of disease and radiological changes of wrist.