Vascularized Growth Plate Transfer for Distal Radius Reconstruction

Abstract

Distal radius reconstruction in children should meet two requests: restoration of some joint function and preservation of the physiologic growth of the segment. None of the conventional options is likely to successfully achieve both goals. Conversely, a vascularized transfer of the proximal fibula including the growth plate provides enough bone stock for diaphyseal reconstruction, an articular surface for joint function, and the potential for longitudinal growth. From 1992 to 2006, eight children ranging in age between 2 and 10 years underwent a vascularized transfer of the proximal fibula for distal radius reconstruction after bone sarcoma resection. The follow-up ranges were between 1 year and 15 years. All the grafts were harvested based on the anterior tibial artery. Seven cases with a follow-up longer than 2 years have been evaluated both clinically and radiographically. All the grafts survived and had a satisfactory growth after the transplant. The functional outcome has been satisfactory, and the range of motion of the reconstructed wrist has been nearly normal in all cases but one. Proximal fibular epiphyseal transfer was an effective procedure for distal radius reconstruction in children who underwent tumor resection. Refinements in the operative technique have increased the reliability of this reconstructive option, which might be safely used also in congenital and posttraumatic disorders.

Composite vascularized fibular epiphyseo‐osteo‐periosteal transfer for hip reconstruction after proximal femoral tumoral resection in a 4‐year‐old child

“…Our case supports the adequacy of this complex technique in the reconstruction of the hip joint after proximal femoral resection for oncologic indications in very skeletally immature patients 1, 2, 4, 5. The use of this delicate procedure in the reconstruction of hips with chronic musculoskeletal changes might compromise its success 3…”

“…The use of a vascularized fibular epiphyseal transplant for the hip reconstruction in a very skeletally immature patient was successful in achieving two objectives: maintaining the joint function and achieving growth 1, 2. The biological reconstruction based on the transfer of the peroneal physis with growth potential, allowed accomplishing both objectives.…”

“…VEFT has been reported as an effective technique in pediatric joint reconstructions of the upper limb, after tumor excision 1, 2. Reconstruction of distal radius and proximal humerus provided good results in terms of achieving both function and growth.…”

Möglichkeiten und Ergebnisse der (freien) vaskularisierten Knochentransplantation im Handbereich

“…tremität ermöglicht werden, um späteren Behinderungen vorzubeugen. Unter Mitnahme der Epiphysenfuge konnten Innocenti et al [20] ein paralleles Wachstum von Ulna und Radius herstellen und bisherige Komplikationen, wie ein Ulna-Impingement oder die radiale Klumphand verhindern. Die Autoren beschrieben nach einem Follow-up von 3 Jahren sehr gute Ergebnisse in der gemessenen Handgelenkbeweglichkeit.…”

New Options for Vascularized Bone Reconstruction in the Upper Extremity

“…Newer options such as the free medial femoral condyle graft and pedicled distal radius grafts can be used to treat carpal bone avascular necrosis and carpal non-unions, whereas vascularized epiphyseal transfer can be used to restore forearm growth in pediatric patients. [9][10][11][12][13][14][15] For bone defects < 6 cm, nonvascularized grafts have been demonstrated to be successful, providing that the graft is covered by well-vascularized tissue and the wound is free of infection. 16 Nonvascularized bone grafts are incorporated into defects through the process of creeping substitution and vascular ingrowth.…”