Giant Cell Tumors of the Upper Extremity: Predictors of Recurrence

PURPOSE: Giant cell tumors (GCT) of the distal radius are thought to be more aggressive than in other locations. Therefore, the aim of this study was to investigate factors associated with recurrence of GCTs in the upper extremity. METHODS: We retrospectively identified 82 patients who underwent primary surgical treatment for an upper extremity GCT. Tumors were located in the radius (n = 47), humerus (n = 17), ulna (n = 9), and hand (n = 9). Treatment consisted of either wide resection or amputation or intralesional resection with or without adjuvants. A multivariable logistic regression was performed including tumor grade, type of surgery, and tumor location, from which the percentage of contribution to the model of each variable was calculated. RESULTS: The recurrence rate after intralesional resection was 48%; after wide resection or amputation, it was 12%. Two patients developed a pulmonary metastasis (2.4%). In multivariable analysis, intralesional resection was independently associated with recurrence. Intralesional resection had a 77% contribution to predict recurrence and the distal radius location had a 16% contribution in the predictive model. CONCLUSIONS: As expected, intralesional resection was the strongest independent predictor of recurrence after surgical treatment for GCT. The distal radius location contributed to the prediction of giant cell tumor recurrence to a lesser extent. TYPE OF STUDY/LEVEL OF EVIDENCE: Prognostic IV

Interobserver reliability of coronoid fracture classification : two-dimensional versus three-dimensional computed tomography

Purpose : This study tests the hypothesis that 3-dimensional computed tomography (CT) reconstructions improve interobserver agreement on classification and treatment of coronoid fractures compared with 2-dimensional CT.Methods : A total of 29 orthopedic surgeons evaluated 10 coronoid fractures on 2 occasions (first with radiographs and 2-dimensional CT and then with radiographs and 3-dimensional CT), separated by a minimum of 2 weeks. Surgeons classified fractures according to the classifications of Regan and Morrey and of O\u27Driscoll et al., identified specific characteristics, recommended the most appropriate treatment approach, and made treatment recommendations. The kappa multirater measure (&kappa;) was calculated to estimate agreement between observers.Results : Regardless of the imaging modality used, there was fair to moderate agreement for most of the observations. Three-dimensional CT improved interobserver agreement in Regan and Morrey\u27s classsication (&kappa;3-dimensional = 0.51 vs &kappa;2-dimensional = 0.40; p &lt; .001) and O\u27Driscoll et al.\u27s classifications (&kappa;3-dimensional = 0.48 vs &kappa;2-dimensional = 0.42; p = .009). There were trends toward better reliability for 3-dimensional reconstruction in recognition of coronoid tip fractures (&kappa;3-dimensional = 0.19, &kappa;2-dimensional = 0.03; p = .268), comminution (&kappa;3-dimensional = 0.41 vs &kappa;2-dimensional = 0.29; p = .133), and impacted fragments (&kappa;3-dimensional = 0.39 vs &kappa;2-dimensional = 0.27; p = .094), and in surgeons\u27 opinions on the need for something other than screws or plate for surgical fixation (&kappa;3-dimensional = 0.31 vs &kappa;2-dimensional = 0.15; p = .138). Interobserver agreement on treatment approach was better with 2-dimensional CT (&kappa;3-dimensional = 0.27, &kappa;2-dimensional = 0.32; p = .015).Conclusions : Three-dimensional CT reconstructions improve interobserver agreement with respect to fracture classification compared with 2-dimensional CT.<br /