Midfoot Reconstruction for a Large, Aggressive Giant-Cell Tumor

by Jae Hoon Ahn, Won-Sik Choy, Ha-Yong Kim, and Han-Soo Kim

J Bone Joint Surg AmVolume 93(22):e133November 16, 2011

©2011 by The Journal of Bone and Joint Surgery, Inc.

Photograph of the right foot demonstrating a large mass in the midfoot area.

Jae Hoon Ahn et al. J Bone Joint Surg Am 2011;93:e133

©2011 by The Journal of Bone and Joint Surgery, Inc.

and lateral.

Jae Hoon Ahn et al. J Bone Joint Surg Am 2011;93:e133

©2011 by The Journal of Bone and Joint Surgery, Inc.

radiographs of the foot show diffuse infiltration of an osteolytic lesion into the midfoot area, suggesting the aggressive nature of the lesion.

Jae Hoon Ahn et al. J Bone Joint Surg Am 2011;93:e133

©2011 by The Journal of Bone and Joint Surgery, Inc.

A preoperative T2-weighted transverse MRI scan shows a large expansile mass replacing the medial two cuneiforms and also abutting the lateral cuneiform.

Jae Hoon Ahn et al. J Bone Joint Surg Am 2011;93:e133

©2011 by The Journal of Bone and Joint Surgery, Inc.

A line drawing shows the surgical plan, consisting of excision of the medial two cuneiforms and the proximal two-thirds of the first and second metatarsals, as well as the partial excision of the

lateral cuneiform and the third metatarsal base.

Jae Hoon Ahn et al. J Bone Joint Surg Am 2011;93:e133

©2011 by The Journal of Bone and Joint Surgery, Inc.

A line drawing depicts the reconstruction of the osseous defect with an iliac strut bone graft medially and a cancellous bone graft laterally (cross-hatched area).

Jae Hoon Ahn et al. J Bone Joint Surg Am 2011;93:e133

©2011 by The Journal of Bone and Joint Surgery, Inc.

Photograph after excision of the tumor shows the iliac strut bone graft inserted into the osseous defect and fixed with plates.

Jae Hoon Ahn et al. J Bone Joint Surg Am 2011;93:e133

©2011 by The Journal of Bone and Joint Surgery, Inc.

A standing anteroposterior radiograph of the foot obtained at one year and two months after the operation and two months after the plate and screw removal shows the well-maintained length of

the reconstructed metatarsal bones as well as solid consolidation ...

Jae Hoon Ahn et al. J Bone Joint Surg Am 2011;93:e133

©2011 by The Journal of Bone and Joint Surgery, Inc.

An anteroposterior radiograph of the foot made at five years and six months after the operation shows a fibrous union of the stress fracture in the graft at the level of the Lisfranc joint.

Jae Hoon Ahn et al. J Bone Joint Surg Am 2011;93:e133

©2011 by The Journal of Bone and Joint Surgery, Inc.

A standing lateral radiograph shows that the fibrous union has occurred with mild extension of the distal portion of the graft, thereby decreasing the cavus foot deformity.

Jae Hoon Ahn et al. J Bone Joint Surg Am 2011;93:e133

©2011 by The Journal of Bone and Joint Surgery, Inc.