Giant cell tumor of distal femur with pathological fracture: A case report

Abstract

Giant cell tumor of bone (GCTB) is a mostly benign bone tumor which can occasionally progress to malignancy, usually in chronic cases. It is a common benign and aggressive bone tumor that affects patients aged 20-45 years. A case of giant cell tumor (GCT) of the distal femur is reported here with an intraoperative complication. A 37-year female presented with a 1-month history of painful swelling over her left knee. On clinical examination, the patient had tenderness and swelling on the anterolateral aspect of the knee extending from the distal part of the femur towards the lateral aspect of the knee. Swelling was well-defined, smooth, firm, and uniform in consistency with dimensions of about 12cm x 8 cm. Knee movement was restricted. An X-ray of the affected knee revealed a soft tissue mass arising from the distal femur on its lateral aspect. MRI revealed a soft tissue mass with the cortical breach. In this case, we planned for curettage with bone grafting and bone cementing using a sandwich technique, but while handling the limb, an medial cortical breach occurred, which was then fixed with the help of a distal femur lateral locking plate and cement in the second setting due to unavailability of distal femur plates during the initial surgery. Following surgery, a sample was sent for histopathology, which s/o high-grade giant cell tumor. Because of the high risk of recurrence, the tumor should be completely removed. Finally, the Knee function recreated to minimize the loss. Another options were enblock excision with arthrodesis of the affected joint but that causes joint stiffness other is arthroplasty of the affecting joint with the help of custom-made prostheses but this procedure is too costly thus we opted for the extended curettage with bone cement with bone grafting (Sandwich technique) with plating.