PMC7276591_01
Pre-operative clinical presentation. (a and b)Swelling of size about 4cm x 3cm over 3rd metacarpal bone of the left hand.
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F1
The overlying skin was normal (Fig. 1).
Anteroposterior (a) and oblique (b), radiographs of the left hand, showing a large expansile lesion involving 3rd metacarpal with a characteristic soap bubble appearance.
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F2
The X-ray of the expansile lesion showed characteristic soap bubble appearance (Fig. 2 and 3).
Pre-operative magnetic resonance imaging. (a)T1 coronal image showing isointense expansile lesion over distal two-third of 3rd metacarpal. (b) T2 coronal image showing expansile lesion with mixed-signal intensity.(c) Sagittal short tau inversion recovery image showing hyperintense expansile lobulated lesion subluxating the metacarpophalangeal joint.
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F3
The X-ray of the expansile lesion showed characteristic soap bubble appearance (Fig. 2 and 3).
(a and b)Intraoperative location of the tumor (c) excised tumor.
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F4
GCT mass was exposed in total. GCT mass was excised with margins along with partial osteotomy of the MC bone, leaving behind about 1cm healthy base of MC bone, which appeared normal both intraoperatively and radiologically (Fig. 4).
(a) Reconstruction by 2.5 mm mini plate.(b) C-arm view showing the fibular strut graft fixed with 2.5 mm mini plate.
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F5
Reconstruction of the defect was done using non-vascularized contoured fibular strut graft taken from ipsilateral middle one-third of fibula, fixed with 2.5 mm mini reconstruction plate, along with reconstruction of the collateral ligaments of the MCP (Fig. 5).
H and E stain microscopic image showing. (a) x10, numerous osteoclastic giant cells dispersed throughout the entire stroma.(b) x40, the giant cells contain 20-100 nuclei and the nuclear morphology is similar to the nuclei seen in the stroma.
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F6
The peripheral area showed mature bony trabeculae (Fig. 6).
(a-c) Follow-up at 2 years showing the functional status of the left hand.
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F7
Anteroposterior (a) and lateral (b), radiographs of the left hand, showing complete union of fibular autograft and no signs of local recurrence.
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F8