Primary bone tumors and tumor-like lesions of the wrist: a single-center experience

Year 2022, , 131 - 137, 17.01.2022

Ömer Sofulu

https://doi.org/10.32322/jhsm.991321

Abstract

Aim: The incidence of primary bone tumors of the wrist is increasing. The aim of this study was to examine the characteristics, treatment protocols, complication rates, and functional outcomes of bone tumors of the wrist treated in a tertiary orthopedic oncology center.
Material and Method: We retrospectively analyzed 93 patients with bone tumors located in the wrist (63 distal radius, 23 distal ulna, 7 carpal bone) who were operated on between 2005 and 2020. Demographic information was recorded. Functional outcomes were evaluated with the Musculoskeletal Tumor Society System (MSTS) scoring system.
Results: There were 57 male and 36 female patients. The average follow-up period was 32 months (range 16-163). There were 82 benign and 11 malignant lesions. Distal radius was the most common site of involvement. The most common type of benign tumor in the distal radius and distal ulna was the giant cell tumor (GCT; 26 and 10 patients, respectively). Among the malignant tumors in the distal radius, 5 were Ewing sarcoma, and 2 were osteosarcoma. All patients with malignant lesions underwent wide surgical resection and free vascularized fibular graft (FVFG) reconstruction. Of the malignant tumors in the distal ulna, 3 were Ewing sarcoma, and 1 was osteosarcoma. These were treated with wide resection and FVFG reconstruction (n=3) and wide resection and fibular strut graft (n=1). The rarest site for tumors in the wrist was the carpal bones. Carpal bone lesions included scaphoid (n=5) and lunate (n=2) tumors. In all of these patients, pathological examination indicated intraosseous ganglion cysts. The average MSTS score of all patients was 27 (range 24-30). Of the 36 patients with GCT, 4 (11%) developed local recurrence. One patient with Ewing sarcoma developed local recurrence and underwent secondary amputation. Distant lung metastasis was observed in 5 of 8 patients with Ewing sarcoma.
Conclusion: Our study confirmed that bone tumors in the wrist are rare. Most benign tumors can be treated with curettage and cement augmentation. For malignant tumors, it is possible to restore function with FVFG.

Keywords

wrist, primary bone tumor, benign, malignant, incidence

References

• Henderson M, Neumeister MW, Bueno Jr RA. Hand tumors: Benign and malignant bone tumors of the hand. Plast Reconstr Surg 2014; 133: 814-21.
• Payne WT, Merrell G. Benign bony and soft tissue tumors of the hand. J Hand Surg Am 2010; 35: 1901–10
• Liu W, Wang B, Zhang S, Li Y, Hu B, Shao Z. Wrist reconstruction after en bloc resection of bone tumors of the distal radius. Orthop Surg, 2021;  13: 376-83.
• Yang YF, Wang JW, Huang P, Xu ZH. Distal radius reconstruction with vascularized proximal fibular autograft after en-bloc resection of recurrent giant cell tumor. BMC Musculoskelet Disord 2016;  17: 1-6.
• Mozaffarian K, Modjallal M, Vosoughi AR. Treatment of giant cell tumor of distal radius with limited soft tissue invasion: curettage and cementing versus wide excision. J Orthop Sci 2018; 23: 174-9.
• Xarchas K, Leviet CD. Osteoblastoma of the carpal scaphoid: frequency and treatment. Acta Orthop Belg, 2002;  68: 532-6.
• Murray PM, Berger RA, Inwards CY. Primary neoplasms of the carpal bones. J Hand Surg 1999;  24: 1008-13.
• Zou C, Lin T, Wang B, et al. Managements of giant cell tumor within the distal radius: a retrospective study of 58 cases from a single center. J Bone Oncol 2019;  14: 100211.
• Pradhan A, Reddy KIA, Grimer RJ, et al. Osteosarcomas in the upper distal extremities: Are their oncological outcomes similar to other sites?. Eur J Surg Oncol 2015;  41: 407-12.
• Erol B, Sofulu O. Tricks and pitfalls in the surgical treatment of malignant bone tumours of the forearm in children and adolescents. J Child Orthop 2021; 15: 366-71.
• Enneking WF, Spanier SS, Goodman MA. The classic: a system for the surgical staging of musculoskeletal sarcoma. Clin Orthop Relat Res 2003; 415: 4-18.
• Picci P, Manfrini M, Fabbri N, Gambarotti M, Vanel. Atlas of musculoskeletal tumors and tumorlike lesions: the Rizzoli case archive. Springer Science & Business Media 2014; 5-9.
• Crowe MM, Houdek MT, Moran SL, Kakar S Aneurysmal bone cysts of the hand, wrist, and forearm J Hand Surg 2015;  40: 2052-7.
• Qi DW, Wang P, Ye ZM, et al. Clinical and radiographic results of reconstruction with fibular autograft for distal radius giant cell tumor. Orthop Surg 2016; 8: 196-204.
• Salunke AA, Chen Y, Chen X, et al. Does pathological fracture affect the rate of local recurrence in patients with a giant cell tumour of bone? A meta-analysis. Bone Joint J 2015; 97: 1566-71.
• Chung DW, Han CS, Lee JH, Lee SG. Outcomes of wrist arthroplasty using a free vascularized fibular head graft for Enneking stage II giant cell tumors of the distal radius. Microsurgery, 2013; 33: 112-8.
• Jaminet P, Rahmanian‐Schwarz A, Pfau M, Nusche A, Schaller HE, Lotter O. Fibulo‐scapho‐lunate arthrodesis after resection of the distal radius for giant‐cell tumor of the bone. Microsurgery 2012; 32; 458-62.
• Aycan OE, Sökücü S, Özer D, Çetinkaya E, Arıkan Y, Kabukçuoğlu YS. Primary bone tumors and tumor like lesions of the ulna. Acta Orthop Traumatol Turc 2019; 53: 30-4.
• Exner GU, von Hochstetter AR, Honegger H, Schreiber A. Osseous lesions of the distal ulna: atypical location–unusual diagnosis. Arch Orthop Trauma Surg 2000; 120: 219-23.
• Öztürk R, Arıkan ŞM, Bulut EK, Kekeç AF, Çelebi F, Güngör BŞ. Distribution and evaluation of bone and soft tissue tumors operated in a tertiary care center. Acta Orthop Traumatol Turc 2019;  53: 189-94.
• Li S, Sun C, Zhou X, Shi J, Han T, Yan H. Treatment of intraosseous ganglion cyst of the lunate: a systematic review. ann plast surg 2019; 82: 577-81.
• Kang L, Manoso MW, Boland PJ, Features of grade 3 giant cell tumors of the distal radius associated with successful intralesional treatment J Hand Surg 2010; 35: 1850-7
• Bickels J, Campanacci DA. Local adjuvant substances following curettage of bone tumors. JBJS 2020; 102: 164-74.