Rethinking Reconstruction: Successful Outcomes of En-Bloc Resection for Giant-Cell Tumor of the Distal Ulna – A Case Report

Background: Giant cell tumour (GCT) of bone is a benign yet locally aggressive neoplasm affecting mainly young adults. It is known for local recurrence, rare pulmonary metastases, and occasional malignant transformation. Although the distal femur and proximal tibia are typical sites, involvement of the distal ulna is extremely rare (0.5–2.9% of cases). This rarity, combined with the unique anatomy of the distal ulna, creates challenges in treatment, prompting exploration of alternatives to standard distal radius management. Case Presentation: A 48-year-old female experienced six months of pain and swelling on the ulnar aspect of her left distal forearm, aggravated by minor trauma. Clinical examination identified a firm, tender mass (10×6×4 cm) with limited wrist mobility and diminished grip strength. Radiographs and MRI revealed a multilobular, lytic “soap bubble” lesion. Histopathology confirmed the diagnosis of GCT. After thorough preoperative counseling, the patient underwent en-bloc resection with a 2 cm tumor-free margin and soft tissue stabilization through reattachment of the extensor and flexor carpi ulnaris tendons. Discussion: The anatomical constraints of the distal ulna limit conventional reconstructive techniques. Extensive resection precludes options like the Sauvé-Kapandji procedure, making soft tissue stabilization a simpler, yet effective, solution. En-bloc resection with soft tissue stabilization is a viable treatment for aggressive distal ulna GCT, ensuring oncological safety and preserved wrist function while avoiding complex reconstruction. Continued follow-up is essential for long-term assessment.