Journal of Foot and Ankle Surgery (Asia Pacific)

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VOLUME 7 , ISSUE 1 ( January-June, 2020 ) > List of Articles

CASE REPORT

Giant Cell Tumor of the Distal Tibiofibular Joint: Extensive Curettage, Reconstruction, and Arthrodesis Using Induced Membrane Technique

Sabri Mahjoub, Maamoun Mihoubi, Mourad Zaraa, Liwa Hariz, Mohammed Abdelkefi, Mondher Mbarek

Keywords : Ankle joint, Giant cell tumor of bone, Masquelet technique, Reconstruction, Tumor

Citation Information : Mahjoub S, Mihoubi M, Zaraa M, Hariz L, Abdelkefi M, Mbarek M. Giant Cell Tumor of the Distal Tibiofibular Joint: Extensive Curettage, Reconstruction, and Arthrodesis Using Induced Membrane Technique. J Foot Ankle Surg Asia-Pacific 2020; 7 (1):24-27.

DOI: 10.5005/jp-journals-10040-1115

License: CC BY-NC 4.0

Published Online: 30-07-2020

Copyright Statement:  Copyright © 2020; The Author(s).


Abstract

Aim: Masquelet technique may be used successfully for the reconstruction and arthrodesis of distal tibiofibular joint after tumor resection. Background: Giant cell tumors (GCTs) involving both distal tibia and fibula are exceedingly rare. The optimal surgical treatment in these locations is controversial. Reconstruction of cavitary bone loss after resection is challenging. Case description: We describe an unusual presentation of exophytic GCT affecting distal tibiofibular joint in a 35-year-old man. The optimal surgical treatment was controversial. Collapse of the tibial plafond was the major risk of surgical resection. An extensive intralesional curettage was performed. The size of the resulting bone defect measured 5 cm in fibula and 4 cm × 3 cm × 2 cm (24 cm3) in tibia. Reconstruction of the cavitary bone loss was challenging. Induced membrane technique was performed for the reconstruction of both tibia and fibula. A plate and a cement spacer were used in the first-time procedure. Two months later, the induced membrane was opened longitudinally. The cement spacer was removed and the biological space which had been created was filled with cancellous bone graft obtained from the patient's iliac crest. Two K-wires were placed in order to avoid tibial plafond collapse and were removed after 6 weeks. Bone union was obtained at 2 months. No recurrence or septic complications were observed. Good functional and anatomic results were obtained at 4 years’ follow-up. Conclusion: Reconstruction and arthrodesis of the distal tibiofibular joint represent an excellent indication of Masquelet technique, especially after GCT resection. Clinical significance: The present case highlights therapeutic difficulties in this exceptional location, particularly regarding cavitary bone loss.


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  1. Niu X, Zhang Q, Hao L, et al. Giant cell tumor of the extremity. retrospective analysis of 621 chinese patients from one institution. J Bone Joint Surg Am 2012;94(5):461–467. DOI: 10.2106/JBJS.J.01922.
  2. Klenke FM, Wenger DE, Inwards CY, et al. Giant cell tumor of bone. risk factors for recurence. Clin Orthop Relat Res 2011;469(2):591–599. DOI: 10.1007/s11999-010-1501-7.
  3. Casadei R, Ruggieri P, Giuseppe T, et al. Ankle resection arthrodesis in patients with bone tumors. Foot Ankle Int 1994;15(5):242–249. DOI: 10.1177/107110079401500503.
  4. Ajit Singh V, Nasirudin N, Bernatt M. Endoprosthetic reconstruction for giant cell tumors of the distal tibia: a short term review. Asia-Pac J Clin Oncol 2013;9(2):182–189. DOI: 10.1111/j.1743-7563.2012.01553.x.
  5. Jones RB, Ishikawa SN, Richardson EG, et al. Effect of distal fibular resection on ankle laxity. Foot Ankle Int 2001;22(7):590–593. DOI: 10.1177/107110070102200711.
  6. Monson DK, Vojdani S, Dean TJ, et al. Lateral ankle stabilization after distal fibular resection using a innovative approach: a surgical technique. Clin Orthop Relat Res 2014;472(4):1262–1270. DOI: 10.1007/s11999-013-3408-6.
  7. Nadkarni S, Punit AS, Nair RV. Giant cell tumour of distal fibula managed by en block resection and reconstruction with ipsilateral proximal fibula. J Orthop Case Rep 2015;5(1):52–54. DOI: 10.13107/jocr.2250-0685.255.
  8. Zuo D, Zheng L, Sun W, et al. Contemporary adjuvant polymethyl methacrylate cementation optimally limits recurrence in primary giant cell tumor of bone patients compared to bone grafting: a systematic review and meta-analysis. World J Surg Oncol 2013;11(1):156. DOI: 10.1186/1477-7819-11-156.
  9. Bégué T, Auregan JC. The induced membrane technique for treatment of large segmental or cavitary bone defects: How to maximize the success. Arch Ortop Reumatol 2013;124(1–3):18–19. DOI: 10.1007/s10261-013-0046-1.
  10. Sorensen BW, Mikkelsen P. Arthrodesis of the distal tibiofibular joint for an osteochondroma in the fibula Encroaching on the distal tibia and involving the talocrural joint: a case report. J Foot Ankle Surg 2012;51(5):664–665. DOI: 10.1053/j.jfas.2012.05.014.
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