Incidental Finding of Distal Ulnar Giant Cell Tumour Treated with Preoperative Short Course of Denosumab and Extended Curettage

Abstract

Giant Cell Tumour (GCT) forms 5% of all primary bone tumours. GCT of distal ulna is an extremely uncommon entity being more common in the distal femur, proximal tibia and distal radius, respectively. Wide excision is one of the modalities of treatment, but this creates a bony defect that have to be reconstructed. The case report discusses a 30-year-old Indian male who was diagnosed incidentally with GCT of distal ulna after an alleged history of injury following road traffic accident. It was extremely difficult to perform excision and extended curettage initially due to extensive thinning of the cortex. Denosumab was administered subcutaneously for three months. Daily supplements of calcium 500 mg and vitamin D 400 IU were given. The short course of preoperative Denosumab lead to marked intralesional sclerosis facilitating the less morbid procedure of extended curettage and bone grafting and thus, salvaging the wrist. The functional outcome at one year postoperatively was excellent without any complications. Denosumab has the potential to regress the tumour, thereby preventing the need for complex reconstructive surgeries of the wrist.

Keywords

• bone grafting
• chemical cauterisation
• distal ulna swelling
• neoadjuvant denosumab
• primary bone tumour