Radial Shaft Reconstruction With an Intercalary Endoprosthesis Following Resection of Metastatic Tumor

Improvements in imaging and treatment of musculoskeletal tumors have increased the variety of options for reconstruction following joint-sparing diaphyseal resection. The purpose of this case series was to show that reconstruction of malignant tumors of the radial shaft with an intercalary prosthesis may be an option for patients with segmental bone loss. Three consecutive patients underwent wide resection of the radial diaphysis followed by reconstruction with a custom intercalary prosthesis. A custom intercalary prosthesis with lap joint design was used in all 3 cases. Mean follow-up was 18 months (range, 9-25 months). All patients were weight bearing as tolerated 1 week postoperatively. At the most recent follow-up, patients' mean elbow flexion and extension arc was 137 degrees (range, 130 degrees-140 degrees). At the forearm, mean supination was 60 degrees (range, 30 degrees-90 degrees) and mean pronation was 70 degrees (range, 60 degrees-90 degrees). At the wrist, mean palmar flexion was 80 degrees (range, 70 degrees-90 degrees) and mean dorsiflexion was 80 degrees (range, 70 degrees-90 degrees). All patients reported minimal to no pain and no significant functional limitations. Mean Musculoskeletal Tumor Society score was 26/30 (87%). Reconstruction with an intercalary prosthesis is a viable option for patients with metastatic disease of the radial shaft. All patients had satisfactory results and early return to function; none required return to the operating room. Possible advantages of reconstruction with an intercalary prosthesis compared with reconstruction with a bone graft or polymethylmethacrylate osteosynthesis include early return to function and minimal weight-bearing restrictions postoperatively.