PMC7453115_01
a) Clinical appearance lump on left wrist (case 1). b) pre-op AP Radiograph of the left wrist (Case 1). c) MRI examination of Case 1.
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On examination on the left wrist region, there was a solid mass on the ulnar side, clear margin with swelling, fixated, tenderness (Fig. 1a). A plain radiograph of the left wrist showed a geographic lytic lesion in the distal ulna (Fig. 1b). Magnetic Resonance Imaging (MRI) showed a solid mass with center necrotic, margin relatively clear, size: 6 x 6 x 8 cm full fill intramedullary epimetaphysis os ulna distal that induce ballooning and diluting cortex, pressing surrounding and edema soft tissue (Fig. 1c).
a) Operative photographs showing a large tumor originating from the left ulna (case 1). b) Stabilization ulnar stump using ECU tenodesis technique (case 1). c) AP & lateral radiograph of left lower arm postoperative (case 1).
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The tumor resected with a 3 cm margin of the normal bone proximal to the tumor (Fig. 2a). This created a cuff of the tendon over the end of the ulnar stump, which stabilized the remaining ECU and tethered it toward the radial side of the ulna (Fig. 2b). Patient postoperatively immobilized in a splint with the forearm in supination for four weeks, following which physiotherapy 2 times a week until 3 months post-operative (Fig. 2c).
PMC7453115_02
a) Clinical appearance lump on left wrist (case 2). b) pre-op AP Radiograph of the left wrist (Case 2). c) MRI examination of Case 2.
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Examination on the right wrist region, there was a solid mass on the ulnar side, clear margin, fixated, tenderness (+) (Fig. 3a). A plain radiograph of the right wrist showed a geographic lytic lesion with a soap bubble appearance in the distal ulna (Fig. 3b). MRI showed the primary bone tumor (GCT) (Fig. 3c).
a) Operative photograph showing a large tumor originating from the right ulna (case 2). b) AP & lateral radiograph of right lower arm postoperative (case 2).
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We performed a wide resection of the ulna that included 3 cm of the normal bone (Fig. 4a). The postoperative protocol was similar as described for Case 1 (Fig. 4b).