Large giant cell tumor of first metacarpal: a management dilemma

G iant cell tumors of the hand are rare, accounting for only 2--4% of all giant cell tumors. Giant cell tumors of the first metacarpal are even more rare, and only isolated case reports have been published in literature. Tumors often are juxta-articular and break through the surrounding cortex by the time of diagnosis. Despite the fact that a giant cell tumor is not a sarcoma, its relative high recurrence rate (40--60%) coupled with local aggressiveness after simple curettage may require enbloc excision. In hand lesions, enbloc excision is advocated over ray resection. After simple curettage and grafting, recurrence has been noted in over 80% of giant cell tumors of hand. The extent of the tumors at time of diagnosis and the high recurrence rate after limited resection often dictate the need for an enbloc resection through normal tissues. Such treatment creates a significant skeletal defect and a challenging reconstruction problem. We present a man with a giant cell tumor of the first metacarpal, which was excised and reconstructed, using a free fibular autograft, but because of late recurrence the first ray had to be amputated.