Distal radial osteoblastoma accounts for about 10% of systemic osteoblastomas and is the third most common site of osteoblastoma. As the tumor develops, it is susceptible to pathological fracture, and because of the lack of bone and proximity to the radial-wrist joint, scraping of the lesion is not an appropriate method of management, and the recurrence rate is high. From 2004 to 2009, the authors performed autologous proximal fibula free grafting for reconstruction of the wrist joint in 5 cases of distal radius osteoblastoma (grade III), while widely resecting the tumor segment of the distal radius, and the clinical results were satisfactory. 1, data and methods 5 cases in this group, 2 male, 3 female, age 22-38 years old, 2 cases on the left side, 3 cases on the right side, all cases were routinely diagnosed by preoperative puncture pathology, preoperative radiological examination of the chest and other bone tissues were no abnormality, and the X-rays were all class III according to the Campanacci radiological grading system. All cases underwent imaging examination of the affected limbs to clarify the extent of the lesion and the relationship between the neurovascular and tumor lesions, and contralateral fibula full-length orthopantomograms to exclude abnormal changes in the bone donor area of the fibula. Firstly, the contralateral proximal fibula was cut according to the preoperative measurements, and it was noted that the tibiofibular joint capsule should be cut close to the tibia when cutting the fibula, so that it was preserved on the head of the fibula in order to be sutured to the radial carpal and ulnar-radial joint capsules of the recipient area, and the taken proximal free fibula was preserved in wet saline gauze. Starting from the base of the first metacarpal bone on the radial side of the wrist, through the radial tuberosity, upward to the proximal end of the tumor on the lateral side of the radius, make extensive sharp separation on the palmar and dorsal sides of the tumor, fully reveal the tumor segment of the radius, cut the periosteum of the radius in a circumferential manner at the proximal end of the tumor at a distance of 3~5cm, excise the distal end of the tumor segment, and according to the condition of the lesion, retain the ligamentous tissues of the ulnar-radial joints, and then implant the autologous free fibula after inactivating the wound by soaking in 95% alcohol and distilled water. After soaking and inactivating the wound with 95% alcohol and distilled water, the autologous free fibula was implanted, the carpal ligament was sutured to the capsule of the transplanted fibula, and the free fibula was fixed on the radius with plate screws, and the distal radial ulnar and radial carpal joints were fixed with percutaneous Gerhard’s pins. Postoperatively, the long arm plaster brace was fixed in the flexed elbow position, and was replaced with a plaster tube-type fixation for 12 weeks at the time of discharge from the hospital, the wound was dismantled after 2 weeks, and the Kirschner’s pins for temporary fixation were removed at 8 weeks postoperatively. 2.Results The postoperative pathological results of all cases were consistent with the preoperative diagnosis, and there were no tumor cells at the proximal osteotomy margin of the tumor segment. Follow-up 12~60 months, pain disappeared, no local recurrence and lung metastasis, no intraoperative and postoperative complications, no vascular nerve injury and wound infection, X-ray confirmed that the grafted fibula and the proximal radius had good bone healing, the bone healing time ranged from 6 to 12 months, and the average healing time was 9 months, there was no resorption of the grafted bone and no bone fracture, distal ulna semi-dislocated in 4 cases (including 3 patients with percutaneous Gerdner’s pin fixation of the distal radius-ulnar and radial-wrist joints), no tumor cells on the margins of the proximal osteotomy. wrist joint), 3 cases showed degenerative changes of the wrist joint, and after functional reconstruction of the affected wrist joint, there was no subjective functional limitation, and none of the cases caused physical disability defects, and the MSTS scores were 83-93%. 3.Discussion The incidence of giant cell tumor of distal radius bone is high, rapid growth and destructive, with the development of the tumor, it is easy to destroy the bone and pathological fracture, the basic treatment of giant cell tumor of bone is intracapsular scraping plus adjuvant treatment to eliminate the residual tumor, and bone grafting or bone cement filling the capsule cavity to repair and rebuild the bone defects, but for the patients with giant cell tumor of distal radius bone, Campanacci II~III stage, is it necessary to apply intracapsular scraping or adjuvant treatment to eliminate the residual tumor, and fill the capsule cavity to repair and rebuild the bone defects? , whether intracapsular scraping or whole resection of the lesion should be applied is still controversial. However, for GCT of the distal radius, the recurrence rate after intracapsular curettage and its consequences must be weighed against the loss of function after wrist reconstruction of widely excised lesions in order to decide on the treatment method [1].In patients with GCT of Campanacci stage II~III, the tumor recurrence rate after curettage of the lesion is as high as 50% or more, and they are susceptible to articular surface collapse, which can seriously affect the function of wrist joint or even require amputation , so its function is worse than the efficacy of applying extensive resection plus reconstruction at the beginning, and the reliable and reasonable method is to resect the tumor in its entirety [3], which provides an opportunity to cure the tumor completely. Autologous proximal fibula free graft is widely used in the treatment of distal radius tumors, and the functional effect after reconstruction of the wrist joint is satisfactory. For bone defects larger than 6 cm after resection of GCT tumor segments in the distal radius, free fibular bone grafting can also achieve satisfactory results [5].Noellert applied free fibular bone grafting to replace the distal radius and followed up the case for 14-16 years, and concluded that free fibular bone grafting can achieve bony healing, few complications, and satisfactory carpal function.Rtaimate reported four cases of Giant Cell Tumor Segment of Distal Radius Bone Rtaimate reported 4 cases of free fibular bone grafting after resection of tumor segment of distal radius osteoblastoma, with 4-13 years of follow-up, bone healing time of the implant was 4-9 months, and the wrist function recovered, and the grip strength was restored to normal, which was considered as a very satisfactory result of this kind of wrist reconstruction surgery. In this group of cases, free fibula graft was chosen to treat patients with Campanacci grade III GCT of the distal radius, with a follow-up of 12~60 months, the patients’ pain disappeared, there was no local recurrence and lung metastasis, there was no vascular nerve injury and wound infection, X-ray confirmed that the grafted fibula and the proximal radius had a good bone healing, with the bone healing time of 6~12 months, and the average healing time of 9 months, there was no graft bone resorption and fracture, 4 cases of distal ulna subluxation (including 3 cases of percutaneous Kirschner’s pin fixation of distal radial ulnar and radial carpal joint patients), 3 cases of degenerative changes in the carpal joint, the affected side of the carpal joint function after reconstruction, there is no subjective functional limitation, none of the cases resulted in a physical disability defects, there is no symptom of neurovascular injury, 5 cases of the patients are back to normal work and labor. In this group of cases, although the distal ulnar subluxation occurred frequently, with a frequency of 83%, we considered it to be a minor problem, and it did not affect the wrist joint activity and pain. Wrist mobility was good in the short-term follow-up, and it is not clear whether there was any reduction in joint mobility over time, although three cases showed degenerative changes in the joint during the post-transplantation follow-up, but they were not symptomatic. Because percutaneous Kirschner pin fixation of the distal radial-ulnar joint increases the chances of infection and the distal ulnar subluxation still occurs after removal of the pin, we now do not use it routinely but emphasize more precise suturing of the radial-wrist and radial-ulnar joints to achieve distal ulnar stabilization, especially the angulation of the radial-ulnar joints, which can help to prevent distal deformity and articular degeneration from occurring. There were no local recurrences during the follow-up period of our cases, and we believe that any reasonable treatment must ensure that there is no recurrence of the lesion within 5 years after the initial surgery. Therefore, complete eradication of the primary lesion in the initial surgery is the main method to reduce recurrence. In this group, the giant cell tumor of bone was Campanacci grade III, and the soft tissue resection was 0.5~1.0 cm of normal soft tissue outside the reactive area, and the osteotomy plane was 3~5 cm osteotomized away from the tumor, and was sent to the pathology for examination according to the routine, and it was confirmed that there were no tumor cells at the edge of osteotomy in this group by the pathology. We believe that for GCT patients with Campanacci grade III distal radius, the lesion tissue should be removed as thoroughly as possible to reduce the recurrence rate, and at the same time maximize the maintenance of the wrist joint function, significantly improve the patient’s psychological feelings and improve the patient’s quality of life, and the use of free fibula grafting to replace the distal radius to rebuild the function of the wrist joint is an ideal method of treatment.