Free Fibula Flap Arthrodesis After En Bloc Resection of Distal Radius Giant Cell Tumors: Functional and Oncologic Outcomes From a Single-institution Experience.

Background: Reconstruction of distal radius defects following oncological resection remains technically challenging. Free fibula flap (FFF) arthrodesis offers a biological and durable reconstructive option; however, reports remain limited. Methods: We retrospectively reviewed 8 patients who underwent en bloc resection of Campanacci grade III giant cell tumors (2017-2024) of the distal radius, followed by reconstruction with FFF arthrodesis. Clinical, radiological, and functional outcomes were analyzed, including union, recurrence, complications, donor-site morbidity, and Musculoskeletal Tumor Society, Disabilities of the Arm, Shoulder, and Hand (DASH), and visual analog scale scores. Results: All patients achieved radiographic union (mean 7 mo proximally, 11 mo distally). Median follow-up was 36 months. Seven (87.5%) patients remained disease-free; 1 patient developed multicentric soft-tissue local recurrence with pulmonary metastases, which was managed surgically along with radiotherapy and medical treatment. The patient remained disease-free at last follow-up. Mean Musculoskeletal Tumor Society score was 24.5, DASH score was 20.3, and visual analog scale score was 2.3, indicating satisfactory limb function and minimal pain. Donor-site morbidity was minimal. Conclusions: FFF arthrodesis maintained viability even after postoperative fractures, soft-tissue recurrences, and adjuvant therapy, underscoring its robustness. It represents a valuable microsurgical option when long-term stability and biological incorporation are prioritized.