Giant cell reparative granuloma (GCRG) are non neoplastic fibrous lesions with scattered giant cells and are often found in jaw bones. Their presence in short tubular bones of the hand and feet have been reported (Dorfman), but are rare. Their presence in carpal bones is even rarer
We describe a case of GCRC of the carpal scaphoid in a 56 yr old man who presented with chronic wrist synovitis. Radiological investigations included X rays and MRI scans. Blood investigations were done to rule out hyperparathyroidism as a differential diagnosis. He underwent Extended curettage of the lesion and bone grafting. Histopathologic features were consistent with GCRG. He was rehabilitated gradually with hand therapy and was followed up regularly with x rays to ascertain healing of the scaphoid and look for recurrences. Hand function was assessed using validated outcome measures, including pinch and grip strength, Mayo wrist score and Patient Reported Wrist Evaluation (PRWE).
At the final follow up of 2 yrs post operative, he was asymptomatic with a good wrist function as measured by Mayo wrist score and radiographs revealed a well headed scaphoid with no recurrence of lesion.
Giant cell reparative granuloma of the Scaphoid is a rare presentation with only a handful reported in literature. Diagnosis is established with x rays and advanced imaging modalities like CT scan and MRI. Histopathological confirmation is mandatory and extended curettage with bone grafting is curative. In case of large lesions excision of the affected carpal bone and limited carpal fusion may be necessary. Long term follow up is needed to detect recurrences early.
