Hemi-Fibular Grafting for Metacarpal Giant Cell Tumor – Surgical Technique

Introduction: Giant cell tumor (GCT) of small bones of hand is no so uncommon, especially in the metacarpals. Considering the aggressive behavior in the metacarpals, en bloc resection is often required. Following resection, reconstruction techniques available include tricortical iliac grafting, vascularized or non-vascularized fibular grafting, or metatarsal grafting. We present an innovative surgical technique for the management of such bone defects.

Case report: A 14-year-old girl presented with pain and swelling over the dorsum of the right hand for 2 months which was progressively increasing in size. The range of movements of the metacarpophalangeal (MCP) joint was normal. Radiological evaluation showed a lytic lesion with a well-defined margin over the metaphyseal region of the second metacarpal without articular involvement. The lesion was diagnosed as GCT on biopsy. Reconstruction of bone loss was managed by hemi-fibular grafting technique which involves selective osteotomy of the anterior half of the middle third of the fibula for the reconstruction of bone loss. This new technique ensures a renewable source of autograft with good incorporation at the recipient site with good hand function despite maintaining the esthetic appearance of the hand. Lesion being very aggressive had two episodes of recurrence at 2-3 years of post-operative period which was excised.

Conclusion: This case illustrates the management of aggressive GCT of metacarpal bone by excision and reconstruction with hemi-fibular grafting technique. Hence, hemi-fibular grafting can be considered as an innovative technical substitute to the traditional methods of autograft harvesting with good regenerative potential at the donor site and better incorporation rates at the recipient site providing good functional results.