Malignant Giant Cell Tumor of the Wrist with Subsequent Flexor Pollicis Longus Rupture: A Case Report and Rehabilitation Outcomes

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Background: Malignant giant cell tumor of bone (MGCTB) is a rare and challenging tumor characterized by malignant atypical cells within a benign giant cell tumor structure. Due to its scarcity and unique pathology, MGCTB lacks established treatment protocols, presenting difficulties in clinical management and postoperative care.

Case Presentation: A 59-year-old male presented with MGCTB in the wrist, for which he underwent wide tumor resection and allogeneic bone grafting. One year post-surgery, the patient experienced a rupture of the right flexor pollicis longus (FPL) tendon, presenting as an inability to flex his right thumb during daily activities. Following tendon grafting surgery, a modified Kleinert protocol was initiated on the first postoperative day, with active motion exercises starting on day 23. Despite extensive rehabilitation efforts, including the use of a wrist splint and range-of-motion exercises, bone fusion remained incomplete after one year. To improve functional outcomes, a specialized brace supporting wrist extension and joint rotation was introduced, complemented by graded splinting in occupational therapy (OT). Upon completing OT, the Musculoskeletal Tumor Society (MSTS) score improved from 16/30 (53%) to 24/30 (80%), and the Toronto Extremity Salvage Score (TESS) increased from 10.8/100 to 48.3/100. The patient regained adequate hand function for daily activities, allowing him to return to work post-OT.

Conclusion: Despite the absence of complete bone fusion, graded splinting and OT significantly improved hand function and facilitated a timely return to work in this rare MGCTB case. This report highlights the critical role of rehabilitation in managing MGCTB patients facing complex postoperative challenges.