Long Term Results of Epiphyseal Transplant in Distal Radius Reconstruction in Children

Abstract

▼Background: Replacement of osseous defect, restoration of joint function, and restoration of longitudinal growth are the 3 main reconstructive issues that need to be addressed when the physis and epiphysis are damaged in a skeletally immature individual. Failure in achieving these objectives leads to severe deformity and functional impairment, which significantly compromises the quality of life of young patients. Because of its biological and morphological characteristics, the proximal fibula epiphyseal transfer has proven to be an excellent option in limb salvage surgery in pediatric oncologic cases meeting all the reconstructive requirements. Methods: Between 1992-2006, 8 children with a mean age of 7.3 years (range 4-11 years old) diagnosed with malignant bone tumor of the distal radius underwent tumor resection and immediate microsurgical reconstruction of the distal part of the radius with vascularized proximal fibular transfer, which included the physis and a variable length of the diaphysis. The anterior tibial vascular network supplied all of the grafts. One patient died to lung metastasis, 3.5 years after surgery; a second patient was lost at followup. The remaining 6 patients were periodically followed up both clinically, measuring range of motion, grip strength and the sensation of the hand, and by means of standard x rays, bone scan and CT scan. Results: The mean follow-up was 13.2 years (range, 8-22 years). All the transfers survived and underwent fusion at the recipient site. In our experience the fibular growth expected after the transplant, ranges between 0.7 and 1.4 cm per year. In this series growth arrest occurred in only one patient after trauma. Serial radiographs and CT scans revealed progressive remodeling over time of the new articular surface. The functional result was rated as excellent in all but the

Composite-Free Vascularized Fibular Epiphyseal Flap and Proximal Humeral Allograft for Proximal Humerus Reconstruction in a Pediatric Patient

“…Free vascularized fibula flaps are widely used for many reconstructive scenarios, including physeal transfer first described by Innocenti et al 20 They are beneficial compared with other vascularized grafts because of the presence of an articular surface for creation of a neoarticular joint and a tubular structure for reconstruction of long bone defects. 6 , 18 , 21 In the proximal humerus, survival of the physis and creation of a neoglenofibular joint have been successful, but a high rate of graft fracture is noted, usually within the first year before enough graft hypertrophy has occurred because of the diameter mismatch between the fibula and humerus. 1 , 5 - 7 One study looked at 11 proximal humerus physeal transfers and reported a 66% graft fracture rate within the first year.…”

“…A transient peroneal palsy and foot drop is to be expected as branches of the deep peroneal nerve may need to be divided and repaired to disarticulate the fibular head during harvesting. 15 , 21 Rarely is the foot drop permanent (2.6%). 21 At the follow-up, the patient's range of motion was limited but as expected.…”

Vascularized second metatarsophalangeal joint transfer for radial deficiency – an update

“…The palsies have been mostly transient, but some have been followed by a long-term peroneal weakness. Importantly, the potential for growth at the proximal fibula epiphysis has been questioned and may depend upon which arterial pedicle(s) is used, although recent experiences with a reversed anterior tibial artery pedicle, when replacing the distal radius in the treatment of bone malignancies, have shown a positive growth potential (Innocenti et al., 2015). Finally, we do not know if a proximal fibular epiphyseal transfer will enhance the longitudinal growth of the ulna and result in longer forearms.…”

Fibular epiphyseal transfer: the peroneal vessels revisited

“…Later series have cited these equivocal results to assert that the anterior tibial pedicle is the best choice to provide blood supply both to the epiphysis and diaphysis with a single pedicle. Innocenti et al 8,9 showed favourable outcomes in six children using fibular epiphyseal transfer based on the anterior tibial artery. All achieved bony union and longitudinal growth.…”