1. The document discusses treatment options for giant cell tumor of the distal radius, including extended curettage with adjuvant therapies like phenol or bone cement for lower grade tumors, and en bloc resection with reconstruction using osteochondral allograft or arthrodesis for higher grade tumors. 2. Studies have found that extended curettage with cement has a high local control rate and good functional outcomes compared to wide resection. 3. Reconstruction options after tumor resection include osteoarticular allograft, vascularized fibular graft, or arthrodesis depending on the extent of bone loss and need to preserve wrist or forearm function.

1. Giant cell tumor of Distal Radius Sumroeng Neti, M.D. (1st class honors) Orthopedic Center Bumrungrad International Hospital

5. Plain radiograph Tumor effect to bone - Purely lytic : geographic pattern - Eccentrically located in the epiphyses and abut the subchondral bone Bone response to tumor - Expansile - Margin : Distinct or poorly outlined : Classically nonsclerotic : Erosion through the cortex

10. Conventional Surgical Treatment GCT of bone Grade En Bloc excision & R econstruction Grade 3 Extended curettage C ement or Bone graft Grade 1 & 2

19. Case # 1

27. Dx : GCT of Distal Radius stage III : Aggressive Rx : En Bloc resection + osteochondral allograft with good result

30. Case # 2 35 year – old Thai male

43. 4 months postop.

44. 8 months postop.

45. 1 year & 1 month postop.

46. 1 year & 6 month postop.

47. 1 year & 8 month postop.

48. Dx : GCT of Distal Radius stage III : Aggressive Rx : En Bloc resection + osteochondral allograft with allograft collapse

49. Case # 3 21 year – old female S/P wide resection + allograft arthrodesis

50. 1 year postop.

51. 3 year postop.

60. Dx : GCT of Distal Radius stage III : Aggressive 1 st Rx : En Bloc resection + osteochondral allograft with allograft fracture, nonunion 2 nd Rx : Free vascularized fibular bone graft

62. Case # 4 52 year – old female

70. After curettage

71. After burring

72. After phenol & alcohol

73. After cementing

76. 1 year 2 months postop.

77. 1 year 9 months postop.

78. 1 year 9 months postop.

79. Dx : GCT of Distal Radius stage III : Aggressive Rx : Extended curettage (+ phenol) & bone cement [ No recurrence within 2 years]

83. Currently recommended Surgical Treatment GCT of bone Grade En Bloc excision & R econstruction Grade 3 c marked destruction Extended curettage C ement or Bone graft - Grade 1, 2, 3 s marked destruction -

84. Reconstruction for Distal Radius

86. Thank you for your attention