From misdiagnosis to saved wrist: how LLUH’s ortho-oncology saved a hand from amputation

What began as a dull, persistent wrist pain from carrying heavy items during a move, 36-year-old Jimmy Soto ignored his pain as a minor injury. Over the next month, his pain not only worsened, but his wrist and hand began to swell until they were three times their normal size.

Concerned, Soto went to a local hospital near his home, where he received a shocking diagnosis.

"Without taking any tests, the doctors told me I had cancer, and they would have to amputate my hand," Soto recalled.

After talking to his wife, Soto decided to get a second opinion, which led him to the orthopaedic department at Loma Linda University Health, a decision that saved his hand from amputation.

An accurate diagnosis

Unlike his first experience, the care team at Loma Linda approached his case with thoroughness and reassurance. Rather than jumping to amputation, Soto underwent several tests that showed he had an aggressive giant cell tumor in his wrist, but not cancer.

Soto was given two options for surgery -- an artificial bone implant or a bone flap using his own tissue.

"The surgeons told me they could remove the tumor and replace the messed-up wrist bone with a piece of bone from my leg for the best long-term results," Soto said. "I decided to go with that option."

A 12-hour surgery

Surgery was led by orthopaedic surgeons Andrew Kantzos, MD, and Andrew Li, MD, and took place over many hours.

During the procedure, both surgeons operated simultaneously. While Li worked on harvesting the flap, which consisted of the fibula bone, the connected overlying skin paddle, along with its blood supply, Kantzos began operating on the wrist.

Soto's decision to use bone from his leg to replace the tumor-infected bone meant that Li needed to harvest a section of the fibula, along with overlying skin, while keeping both connected through critical blood vessels.

"This technique preserved the tissue blood supply, allowing the bone and skin of the flap to remain viable," Li explained. "To accomplish this, the segment was carefully removed as a single unit, still attached to its vascular connection, before being transferred to the arm."

Meanwhile, Kantzos focused on accessing the tumor by removing tendons and nerves to reach the affected area. To do this, Kantzos cut a long incision along the back of the arm to remove tendons and nerves to access the tumor.

"Once everything was out of the way, we peeled the diseased bone out of the wrist," Kantzos said. "The bone was so weakened that it was mush-like and could have been pushed through with a finger."

Once the tumor-affected bone was removed, the fibula graft was shaped to fit the arm. Kantzos aligned the fibula with the remaining bone, and Li went on to reconnect the blood vessels of the flap to those of the arm and restore circulation. This critical step kept the transplanted bone alive, allowing it to integrate naturally with Soto's body -- a process that can take up to two years.

Recovery from surgery

For the first three days of Soto's recovery, the pain was overwhelming.

"I fainted twice. It was that painful," he said.

His care team closely monitored blood flow to his hand, frequently checking the artery to ensure proper healing. Additionally, because both his wrist and leg were operated on, mobility was a major challenge. He remained in the hospital for nearly a week.

Today, Soto's hand has returned to normal in size and continues to improve with daily exercises. His leg is also healing, and he has progressed from a wheelchair to crutches to walking independently.

"I'm really happy with the work Dr. Li and Dr. Kantzos did. I appreciate the whole team."

Family support

Soto credits his wife for pushing for a second opinion. The couple has two autistic sons, both of whom receive care through Loma Linda, which is how Soto ended up seeking the hospital for their opinion.

"They didn't just treat my condition," he said. They supported my family and answered every question, no matter how small. They gave me my hand back."