(P 527) SALVAGE OF AN OSTEOARRTICULAR ALLOGRAFT RADIUS RECONSTRUCTION SINGLE BONE TRANSPOSITION WITH WRIST ARTHRODESIS FOLLOWING OSTEOSARCOMA EXCISION

Objective: Reconstruction of the distal radius with an osteoarticular allograft after sarcoma resection can be complicated by both instability and degenerative changes. The purpose of this report is to demonstrate the salvage -progression and treatment of wrist instability and degenerative changes after resection of an osteosarcoma of the radius initially treated with an osteoarticular allograft.

Methods: A 15 year old right hand dominant female had an aggressive high grade conventional osteosarcoma of the left radius. The patient initially underwent resection of 11 cm of distal radius at her initial procedure that was reconstructed with a matched bulk osteoarticular distal radius allograft. Seven months after surgery there was a concern for local recurrence, and 5 cm of the distal ulna was resected. There was no evidence of local recurrence on final pathology. The patient subsequently instability and degenerative changes with pain in her wrist joint and loss of function. Seventeen months after her initial surgery she was treated with arthrodesis of the distal radius allograft to the scaphoid and lunate.

Results: Progressive union at the radial shaft osteotomy site began at approximately 6 months after the initial surgery. The radial shaft osteotomy site demonstrated full fusion 1.5 years post operatively. After fusion of the distal radius osteoarticular allograft to the scaphoid and lunate, the patient had an uneventful post operative course. The patient was able to resume regular fine motor activities with her digits and returned to cheer squad. At her most recent follow- up at 3.5 years after surgery, the patient has 20 degrees of wrist extension, 50 degrees of wrist flexion, near full rotation and a symmetric grip. There is no evidence of local recurrence.

Conclusion: Reconstruction of the distal radius with an osteoarticular allograft to preserve the wrist joint is a useful treatment option for reconstruction of large upper extremity defects post sarcoma resection. Fusion of the allograft can be performed to treat instability and pain due to degenerative changes with maintenance of some wrist range of motion and adequate function.