Functional Outcome and Complications of Wide Excision of the Distal End of Radius and Reconstruction with Ulnar Transposition in Campanacci Grade III Giant Cell Tumor: A Longitudinal Study of 14 Cases in South India

Introduction: Giant cell tumor (GCT) of the bone is an intermediate, locally aggressive neoplasm with a high incidence in the Indian subcontinent. The distal radius is a frequent site, often presenting with extensive cortical destruction (Campanacci Grade III), necessitating en bloc resection. Reconstructing the resulting defect remains a challenge in orthopedic oncology. This study evaluates the functional and oncological outcomes of ulnar transposition after radial resection. Material and Methods: A cohort of 14 patients with Grade III GCT of the distal radius underwent en bloc resection and reconstruction with ipsilateral ulnar transposition between 2015 and 2023. Functional outcomes were assessed using the Musculoskeletal Tumor Society (MSTS) score, grip strength measurements, and range of motion (supination and pronation). Radiological union times at the ulno-radial and ulno-carpal junctions were recorded. Results: In our study, we have a total study sample of 14 cases. Both males and females have equal preponderance for GCT of bone. Mean age was calculated to be 39 ± 13.3 years. Mean of the VIII MSTS score was 26.21 ± 1.67. Majority of the patients (78%) have no pain post-operatively. Mean time taken for ulno-radial union was 6.5 months and for ulnocarpal union was 5.7 months. There is a strong agreement of Hand Grip Strength score between affected and unaffected hand Cronbach's alpha +0.961. Mean of supination was 83.57 ± 8.419 (range 70-90°). Mean pronation was 75 ± 9.405 (range from 60 to 90°). The mean of actual grip strength of the affected hand is 16.15 Kg as compared to 31.78 kg for the opposite side. In 64% of cases were not having any post-operative complications associated with surgery. There were only 4 cases (28.5%) of implant failure associated with non-union. One case (7%) of recurrence was noted. Conclusion: Ulnar transposition is an effective, technically accessible biological reconstruction that avoids the complications of fibular grafting or prosthetics. It provides a stable, painless wrist while preserving significant forearm rotation, making it a viable option for aggressive distal radius tumors.