RECONSTRUCTION OF THE DISTAL ASPECT OF THE RADIUS WITH USE OF AN OSTEOARTICULAR ALLOGRAFT AFTER EXCISION OF A SKELETAL TUMOR

Twenty-four patients had reconstruction of the distal aspect of the ra dius with use of an osteoarticular allograft, between 1974 and 1992, a fter excision of a giant-cell tumor (twenty patients), a desmoplastic fibroma (two patients), a chondrosarcoma (one patient), or an angiosar coma (one patient). Nine giant-cell tumors were recurrent lesions, and eleven were extracompartmental primary lesions that had extended thro ugh the cortex or subchondral bone. The average age of the patients wa s 31.5 years (range, fifteen to sixty-one years); thirteen patients we re female and eleven were male. Seventeen lesions involved the right w rist and seven involved the left wrist. The reconstruction was perform ed through a dorsoradial incision with use of a size-matched, preserve d, fresh-frozen, distal radial allograft. All procedures included inte rnal fixation and reconstruction of the radiocarpal ligaments. All pat ients were followed for a minimum of two years (average, 10.9 years; r ange, 2.1 to 22.3 years). At the time of follow-up, two patients - one who had a giant-cell tumor and one who had a desmoplastic fibroma - h ad a local recurrence. Eight patients needed a revision of the osteoar ticular allograft, at an average of 8.1 Sears (range, 0.8 to 17.8 year s) after the initial reconstruction. Seven of these patients had an ar throdesis and one had an amputation. The reason for the revision was a fracture of the allograft in four patients, recurrence of the tumor i n one, pain in two, and volar dislocation of the carpus in one. There were fourteen other complications, including ulnocarpal impaction nece ssitating excision of the distal aspect of the ulna (four), painful ha rdware necessitating removal (four), rupture of the extensor pollicis longus tendon necessitating transfer of the extensor indicis proprius (two), fracture of the allograft necessitating open reduction and inte rnal fixation (two), volar dislocation of the carpus necessitating clo sed reduction (one), and a ganglion of the dorsal aspect of the wrist necessitating excision (one). Of the sixteen patients in whom the oste oarticular allograft survived, three did not have pain, nine had pain in association with strenuous activities, and four had pain in associa tion with moderate activities. Three patients reported ho functional l imitation, nine had limitation in the ability to perform strenuous act ivities, and four had limitation in the ability to perform moderate ac tivities. The average range of motion of the wrist was 36 degrees of d orsiflexion, 21 degrees of volar flexion, 16 degrees of radial deviati on, 15 degrees of ulnar deviation, 58 degrees of supination, and 72 de grees of pronation. Reconstruction of the distal aspect of the radius with use of an osteoarticular allograft was associated with a low rate of recurrence of the tumor, a moderately high rate of revision, littl e pain in association with common activities, good function, and a mod erate range of motion. Osteoarticular allografts are an option for rec onstruction of the distal aspect of the radius after excision of a mal ignant tumor or a recurrent or locally invasive benign lesion.