Functional Outcome of En Bloc Excision and Osteoarticular Allograft Replacement With the Sauve-Kapandji Procedure for Campanacci Grade 3 Giant-Cell Tumor of the Distal Radius Robert M. Szabo, MD, Kurt A. Anderson, MD, James L. Chen, MPH From the Department of Orthopaedic Surgery, University of California, Davis, Sacramento, CA. Purpose: Multiple options have been reported for reconstruction of Campanacci grade 3 giant-cell tumor of the distal radius after resection. In 1990, the senior author described an allograft reconstruction combined with a Sauve-Kapandji procedure after distal radius resec- tion and reported preliminary results in 3 patients. The purpose of this study was to assess with validated patient outcome surveys the intermediate to long-term outcomes of all patients treated with this surgery and to analyze their functional results and document tumor control. Methods: All cases of distal radius osteoarticular allograft combined with the Sauve-Kapandji reconstruction for Campanacci grade 3 giant-cell tumors performed from 1986 to 2000 by a single surgeon were evaluated by clinical and radiologic examinations; the Disabilities of the Arm, Shoulder, and Hand questionnaire; the Short Form–36; and Mayo Wrist scores. Results: Nine consecutive patients (7 women, 2 men) with an average age at follow-up evaluation of 42 years and with a Campanacci grade 3 giant-cell tumor of the distal radius formed the study population. Clinical follow-up time after reconstruction averaged 7 years. Examination showed an average of 51° of extension and 19° of flexion of the wrist and 63° of supination and 79° of pronation of the forearm. Grip strength measured in 5 patients averaged 23 kg. The Disabilities of the Arm, Shoulder, and Hand questionnaire; the Short Form–36; and the Mayo Wrist scores averaged 15, 72, and 73, respectively. These scores indicate modest functional impact. No patient had tumor recurrence, metastases, nonunion, or proximal ulna instability. Conclusions: En bloc resection of a Campanacci grade 3 giant-cell tumor of the distal radius followed by reconstruction with an osteoarticular allograft and a Sauve-Kapandji procedure with autogenous bone graft results in a reasonable functional outcome at intermediate to long-term follow-up evaluation. (J Hand Surg 2006;31A:1340 –1348. Copyright © 2006 by the American Society for Surgery of the Hand.) Type of study/level of evidence: Therapeutic IV. Key words: Giant-cell tumor, distal radius, Suave-Kapandji, wrist, allograft. G iant-cell tumor (GCT) of bone is an ag- gressive lesion, with both a high rate of recurrence after primary treatment and the potential to metastasize to the lungs. 1–7 The distal radius is the third most common location of GCTs. 1 Giant-cell tumors of the distal radius are particularly challenging to treat because of late detection, often with cortical breakthrough. Their proximity to multiple tendons, the median nerve, the radial artery, and the carpus can make resection and reconstruction demanding. Because of the fre- quency of recurrence after curettage in Cam- panacci grade 3 tumors, 1–4 en bloc excision that completely removes the tumor is often needed, but distal radial allograft or fibula graft reconstruction may be complicated by radiocarpal or distal radio- ulnar joint (DRUJ) instability, poor range of mo- tion, and/or donor site morbidity. 7 1340 The Journal of Hand Surgery