Integrated Bone and Ligamentous Reconstruction of the Distal Radius After Oncologic Resection: Proximal Fibular Autograft Combined with Distal Oblique Bundle Reconstruction

Campanacci grade III giant cell tumors of the distal radius frequently require en bloc resection to achieve adequate oncologic control. Reconstruction of the resulting defect remains challenging, particularly with respect to preservation of distal radioulnar joint stability and forearm rotation. Although proximal fibular autograft reconstruction is well established, ligamentous stabilization of the distal radioulnar joint is rarely incorporated in oncologic settings. This technical note describes an integrated reconstructive strategy combining proximal fibular autograft with distal oblique bundle reconstruction, illustrated by a representative clinical case. The technique involves segmental en bloc resection of the distal radius followed by reconstruction using an ipsilateral, nonvascularized proximal fibular autograft including the fibular head. Distal radioulnar joint stability is addressed through reconstruction of the distal oblique bundle using an autologous palmaris longus tendon graft. Surgical indications, operative steps, donor site stabilization, and perioperative management are detailed. Functional evolution was assessed using the Musculoskeletal Tumor Society scoring system and range-of-motion measurements. Histopathological examination confirmed negative oncologic margins. Early postoperative events included donor-site common peroneal nerve dysfunction and radiocarpal instability requiring temporary Kirschner wire stabilization. At nine months, the Musculoskeletal Tumor Society score reached 80%, with forearm rotation preserved at 68.8% pronation and 81.3% supination of normal values. Combined osseous and ligamentous reconstruction following distal radius resection is technically feasible and may allow preservation of distal forearm mechanics while maintaining oncologic principles. Broader validation will require application in larger clinical series and longer follow-up.