Reconstruction of a Posttrauma Arthritic Distal Radioulnar Joint by Vascularized Second Metatarsophalangeal Joint Transfer

Lim, Beng-Hai; Loh, Sir-Young

doi:10.1097/01.prs.0000197137.40001.dc

Cited by 5 publications

(4 citation statements)

References 15 publications

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“…In small or medium-sized joint reconstruction, vascularized free joint transfers have demonstrated excellent durability. [6][7][8][9][10][11][12][13][14] The small size of available expendable joints is the limiting factor of its use in larger joint reconstruction. The use of the hallux MTPj has been reported for elbow reconstruction, 9 with limited success and significant donor morbidity.…”

Section: Discussionmentioning

confidence: 99%

“…In small or medium-sized joint reconstruction, vascularized free joint transfers have demonstrated excellent durability. 6–14…”

Section: Discussionmentioning

confidence: 99%

“…6 Toe PIP or MTPj transfers have been used in finger reconstruction, especially in children 6,7 and for thumb carpometacarpal joint reconstruction. 8 The use of vascularized joint transfers for reconstructing medium-sized joints has been rarely reported, [9][10][11][12] and it is limited by the small size of available expendable donor joints (basically toe MTPjs). The use of a less expendable donor joint, the distal radioulnar joint, has been described as a pedicled vascularized transfer for radiocarpal reconstruction, with questionable risk-benefit ratio.…”

Section: Discussionmentioning

confidence: 99%

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Radiocarpal Joint Reconstruction with a Double Free Metatarsophalangeal Joint Transfer

Cavadas,

Padial

2023

Plastic and Reconstructive Surgery - Global Open

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Background: Destruction of the radiocarpal and midcarpal joints causes loss of wrist motion, pain, and reduced grip strength. A novel technique for radiocarpal reconstruction is presented. Methods: Two patients who had radiocarpal and midcarpal destruction and osteoarthritis underwent reconstruction using simultaneous bilateral microvascular second metatarsophalangeal joint transfer. The insetting was performed, inverting the distal-proximal orientation of both metatarsophalangeal joints and fixing them with two 2.0 screws in proximal and Kirschner wires in distal. Results: Radiocarpal extension and flexion without pain were preserved after a minimum of 4 years follow-up. Both patients could return to recreational activities. No secondary procedures were needed. Conclusions: This technique could be an alternative for radiocarpal reconstruction, although longer follow-up and more cases are needed.

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Section: Discussionmentioning

confidence: 99%

“…In small or medium-sized joint reconstruction, vascularized free joint transfers have demonstrated excellent durability. 6–14…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Radiocarpal Joint Reconstruction with a Double Free Metatarsophalangeal Joint Transfer

Cavadas,

Padial

2023

Plastic and Reconstructive Surgery - Global Open

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“…In an attempt to overcome these limitations, that is, the need for secondary ligament reconstruction and a wellpreserved sigmoid notch, the whole second metatarsophalangeal (MP) joint has been investigated in biomechanic studies and a clinical case. 17,18 The lateral range of motion of the second MP joint was used to restore pronation-supination. The authors are currently investigating the biomechanics of the osteotomized MT2 with MP joint for complete DRUJ replacement.…”

Section: Discussionmentioning

confidence: 99%

Distal Ulna Reconstruction using the Second Metatarsal: Anatomical Study

Cavadas¹,

Thioné

Martínez³

2016

Jnl Wrist Surg

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Background The ulnar head is a key stabilizer of the wrist and forearm. The authors investigated the possibility of using the second metatarsal bone to replace the distal ulna in an anatomical study. Methods The morphology of the distal ulna and the head of the second metatarsal (MT2) were studied using three-dimensional computerized tomographic (CT) scans of the wrist and foot in 52 patients without pathology related to these two areas, and 11 cadaveric specimens. The radius and height of the best-fit cylinder for both epiphyses were measured in the CT scans and compared. In the cadaveric specimens an osteotomy of the metatarsal neck was performed to rotate 90 degrees the head of the MT2 to match the shape of the distal ulna. Results The osseous morphology of the distal ulna and the head of the MT2 are roughly cylindrical, but differently oriented relative to the diaphyseal axes. In the osteotomized cadaveric MT2specimens, the overall morphology was relatively similar that of the distal ulna. The mean length of the MT2 after the osteotomy was 65 mm. Conclusion The head of the MT2 was found to have a similar cylindrical morphology to that of the ulnar head, with a different orientation. The radius of the cylinder was similar, although the height was bigger for the MT2. After a rotation osteotomy of the neck of the MT2 the overall shape and orientation of the epiphysis was more similar to the distal ulna. A vascularized transfer of an osteotomized MT2 would be an option for autologous reconstruction of the distal ulna in selected patients, but further study is needed in terms of the vascular supply, ligamentous reconstruction, and reconstruction of the sigmoid notch. Level of Evidence Therapeutic, level IV.

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Distal Radio-Ulnar Joint Reconstruction after failed Darrach operation using free autogenous second toe Metatarso-phalangeal joint transfer. Development of the technique and a long-term (over 25 year) follow-up

Vilkki

2021

Injury

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During the development of microvascular surgery in 1980-95 many new methods to overcome different traumatic disorders were studied. Previously unsolved problems could be treated using free tissue transfer. Typical problems in wrist surgery were the painful complications from ulna head resection. No sound or acceptable artificial protheses for ulna head were available. Author did study the possibilities of reversal of resected ulna head using an autogenous microvascular joint transfer. First it was done using cadaver models and evaluating the possibilities of a toe MTP-II joint in replacing the distal radio-ulnar joint. Then same principle was used in three clinical cases. All patients had suffered a poor result after ulna head resection or Darrach procedure. First two cases had complications but third case from year 1994 resulted in a good outcome. This paper introduces the development of a surgical technique for the replacement of the resected ulna head. Also, it will describe the excellent long-term result achieved in the last case with 26-year follow-up. Although today many sophisticated prosthetic replacement techniques have become developed for this purpose, this kind of autogenous reconstruction might have a place in treating similar problems in young posttraumatic patients. Also it demonstrates the potential benefit of microsurgery in a difficult wrist problem.

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Reconstruction of a Posttrauma Arthritic Distal Radioulnar Joint by Vascularized Second Metatarsophalangeal Joint Transfer

Cited by 5 publications

References 15 publications

Radiocarpal Joint Reconstruction with a Double Free Metatarsophalangeal Joint Transfer

Radiocarpal Joint Reconstruction with a Double Free Metatarsophalangeal Joint Transfer

Distal Ulna Reconstruction using the Second Metatarsal: Anatomical Study

Distal Radio-Ulnar Joint Reconstruction after failed Darrach operation using free autogenous second toe Metatarso-phalangeal joint transfer. Development of the technique and a long-term (over 25 year) follow-up

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