Adjuvant Denosumab therapy following curettage and external fixator for a giant cell tumor of the distal radius presenting with a pathological fracture: A case report

INTRODUCTION AND IMPORTANCE: Denosumab is used as a neoadjuvant therapy for giant cell tumours (GCT) prior to surgery to improve surgical clearance and reduce the rate of recurrence. However, the use of denosumab as adjuvant therapy following an external fixator for GCT of the distal radius has not been commonly described. We describe the use of adjuvant denosumab following curettage and external fixation in a patient with GCT of the distal radius presenting with a pathological fracture. CASE PRESENTATION: A 23-year-old male presented with a right distal radius fracture. Imaging was suggestive of a Campanacci grade 3 GCT at the distal radius with a pathological fracture. His chest X-ray was normal. He was managed with a dorsal open distal radius curettage and stabilization of the fracture with an external minifixator. Histology confirmed a GCT and adjuvant denosumab therapy was given. The response was satisfactory and the external fixator was removed at 5 months. At 42 months post-treatment, he had satisfactory function with no evidence of recurrence. CLINICAL DISCUSSION: The extensive involvement of the distal radius and local invasion precluded the use of internal fixation after thorough curettage. Therefore, an external minifixator was applied to stabilize the fracture and started on denosumab following oncology opinion. CONCLUSION: External fixation and adjuvant denosumab may be considered as an option in patients who are not suitable for internal fixation. However, cohort studies with long term follow up is necessary before it can be recommended in routine practice.