Giant Cell Tumor of the Distal Tibiofibular Joint: Extensive Curettage, Reconstruction, and Arthrodesis Using Induced Membrane Technique

Ab s t r Ac t Aim: Masquelet technique may be used successfully for the reconstruction and arthrodesis of distal tibiofibular joint after tumor resection. Background: Giant cell tumors (GCTs) involving both distal tibia and fibula are exceedingly rare. The optimal surgical treatment in these locations is controversial. Reconstruction of cavitary bone loss after resection is challenging. Case description: We describe an unusual presentation of exophytic GCT affecting distal tibiofibular joint in a 35-year-old man. The optimal surgical treatment was controversial. Collapse of the tibial plafond was the major risk of surgical resection. An extensive intralesional curettage was performed. The size of the resulting bone defect measured 5 cm in fibula and 4 cm × 3 cm × 2 cm (24 cm3) in tibia. Reconstruction of the cavitary bone loss was challenging. Induced membrane technique was performed for the reconstruction of both tibia and fibula. A plate and a cement spacer were used in the first-time procedure. Two months later, the induced membrane was opened longitudinally. The cement spacer was removed and the biological space which had been created was filled with cancellous bone graft obtained from the patient’s iliac crest. Two K-wires were placed in order to avoid tibial plafond collapse and were removed after 6 weeks. Bone union was obtained at 2 months. No recurrence or septic complications were observed. Good functional and anatomic results were obtained at 4 years’ follow-up. Conclusion: Reconstruction and arthrodesis of the distal tibiofibular joint represent an excellent indication of Masquelet technique, especially after GCT resection. Clinical significance: The present case highlights therapeutic difficulties in this exceptional location, particularly regarding cavitary bone loss.