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Autologous replacement of the head of the radius-proximal fibula versus second metatarsal base: an anatomic feasibility study. Arch Orthop Trauma Surg 2022; 143:2437-2446. [PMID: 35532813 PMCID: PMC10110721 DOI: 10.1007/s00402-022-04460-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 04/18/2022] [Indexed: 11/02/2022]
Abstract
INTRODUCTION This study investigated the anatomic feasibility of a new surgical therapy option for radial head arthrosis using an autologous vascularized bone graft of the second metatarsal and proximal fibula to recreate the proximal radiohumeral joint. MATERIALS AND METHODS Upper and lower extremities of eleven body donors were evaluated using CT prior to anatomic dissection. Several distinct anatomic parameters were measured on the ipsi- and contralateral radial and fibular head and the second metatarsal base: bone diameter, articular surface diameter, head height, metaphyseal (neck) diameter, articular surface radius, total articular surface area, and angulation of the articular surfaces (facet). Each dissection phase was photographed in a standardized fashion and all measurements were repeated by direct caliper-measurements. RESULTS When comparing the proximal radius and fibula to search for anatomic similarities, similar values were found in the maximum articular surface diameter and minimum and maximum measures of the neck diameter. Comparing the proximal radius and the second metatarsal, statistically similar values were found in the maximum neck diameter performing direct measurements and CT evaluation, the maximum head diameter in CT evaluation and the articular facet angulation. CONCLUSIONS Neither the proximal fibula nor the base of the second metatarsal are ideal bone grafts for replacement of the head of the radius. The base of the second metatarsal might be a bit more suitable as a potential donor since the angulation of the proximal articular facet is similar to that of the radius. LEVEL OF EVIDENCE Level IV, anatomic study.
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Ferreira N, Saini AK, Birkholtz FF, Laubscher M. Management of segmental bone defects of the upper limb: a scoping review with data synthesis to inform decision making. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2021; 31:911-922. [PMID: 33674937 DOI: 10.1007/s00590-021-02887-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Accepted: 01/26/2021] [Indexed: 12/18/2022]
Abstract
PURPOSE Injuries to the long bones of the upper limb resulting in bone defects are rare but potentially devastating. Literature on the management of these injuries is limited to case reports and small case series. The aim of this study was to collate the most recent published work on the management of upper limb bone defects to assist with evidence based management when confronted with these cases. METHODS Following a preliminary search that confirmed the paucity of literature and lack of comparative trials, a scoping review using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for Scoping Reviews (PRISMA-ScR) was conducted. A literature search of major electronic databases was conducted to identify journal articles relating to the management of upper limb long bone defects published between 2010 and 2020. RESULTS A total of 46 publications reporting on the management of 341 patients were reviewed. Structural autograft, bone transport, one-bone forearm and the induced membrane technique were employed in an almost equal number of cases. The implemented strategies showed similar outcomes but different indications and complication profiles were observed. CONCLUSION Contemporary techniques for the management of post-traumatic upper limb bone defects all produce good results. Specific advantages, disadvantages and complications for each modality should be considered when deciding on which management strategy to employ for each specific patient, anatomical location, and defect size.
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Affiliation(s)
- Nando Ferreira
- Division of Orthopaedic Surgery, Department of Surgical Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, 7505, South Africa.
| | - Aaron Kumar Saini
- Division of Orthopaedic Surgery, Department of Surgical Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, 7505, South Africa
| | - Franz Friedrich Birkholtz
- Walk-A-Mile Centre and Department of Orthopaedics, University of Pretoria, Pretoria, 0002, South Africa
| | - Maritz Laubscher
- Orthopaedic Research Unit (ORU), Division of Orthopaedic Surgery, Department of Surgery, University of Cape Town, Cape Town, 7505, South Africa
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Cano-Luís P, Andrés-Cano P, Ricón-Recarey FJ, Giráldez-Sánchez MA. Treatment of posttraumatic bone defects of the forearm with vascularized fibular grafts. Follow up after fourteen years. Injury 2018; 49 Suppl 2:S27-S35. [PMID: 30219144 DOI: 10.1016/j.injury.2018.07.021] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2018] [Revised: 07/17/2018] [Accepted: 07/23/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND Among several techniques proposed for the reconstruction of posttraumatic bone defects of the forearm, that of free vascularised fibular graft (FVFG) is one of the most widely used. PATIENTS AND METHOD We study the long-term outcomes of 14 patients who underwent FVFG between 1994 and 2009, with a minimum follow up of 8 years and a maximum of 23 years (mean: 13.9 years). Demographic, clinical and radiological variables were collected retrospectively. The DASH scale was used for clinical assessment. RESULTS Fourteen patients were operated on by the same surgeon, applying FVFG for the reconstruction of posttraumatic bone defects of the forearm (three septic non-union of the ulna or radius, five radius fractures, two ulna fractures and four fractures of both bones). The maximum length of the defect was 11 cm and the minimum length was 6 cm. In four cases, reconstruction of the two bones was achieved using the double barrel technique, and in another four cases, an osteoseptocutaneous flap was used. Fixation was performed with 3.5 mm reconstruction plates in thirteen cases and with 3.5 mm screws in one case. Consolidation was obtained in 12 cases (85.7%) after an average time of 4.2 months (range: 2-6.5 months). In one case, consolidation of the proximal ulnar fracture site was not achieved, and in another, following the failure of reconstruction attempts, an arthrodesis was performed. At the end of the follow-up period, the patients had an average DASH score of 17.1 points (range 1.8-68.1). CONCLUSIONS FVFG is a valid option for the reconstruction of posttraumatic bone defects of the forearm. Its use via the double barrel method or as an osteocutaneous composite graft enables the simultaneous reconstruction of both forearm bones and associated soft tissue injuries. Long-term follow-up of patients who have undergone this technique confirms its satisfactory functional and radiological results.
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Affiliation(s)
- P Cano-Luís
- Orthopaedic Surgery and Traumatology Department, Hospital Universitario Virgen del Rocío, Sevilla, Spain.
| | - P Andrés-Cano
- Orthopaedic Surgery and Traumatology Department, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - F J Ricón-Recarey
- Orthopaedic Surgery and Traumatology Department, Hospital Vega Baja, Orihuela, Alicante, Spain
| | - M A Giráldez-Sánchez
- Orthopaedic Surgery and Traumatology Department, Hospital Universitario Virgen del Rocío, Sevilla, Spain
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Ulnar Head Reconstruction with Microvascular Second Metatarsal. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2017; 5:e1284. [PMID: 28507853 PMCID: PMC5426872 DOI: 10.1097/gox.0000000000001284] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Accepted: 02/06/2017] [Indexed: 11/26/2022]
Abstract
Background: The distal radioulnar joint along with the interosseous ligament of the forearm and the proximal radioulnar joint, form a functionally integrated system responsible for the pronation–supination of the hand. The distal ulna, the so-called ulnar head, is an integral part of this system. Apart from its well-known role in forearm rotation, the ulnar head is essential in transverse load transmission through the distal radioulnar joint upon resisted elbow flexion. Autologous reconstruction of ulnar head would theoretically be beneficial with respect to prostheses. Methods: Three cases of ulnar head reconstruction with microvascular second metatarsal are reported herein including trauma, oncological, and congenital ethiologies. Results: The clinical result was good without complaints of instability. Conclusions: The cases included in this series, although heterogeneous, indicate that this treatment may be feasible also in postoncological resections and in congenital cases.
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Horta R, Nascimento R, Silva A, Pinto R, Negrão P, São-Simão R, Carvalho J, Santos Silva M, Amarante J. Reconstruction of a postraumatic radial club hand with a free fibular osteoseptocutaneous flap and Sauve-Kapandji procedure-A case report. Microsurgery 2016; 36:593-597. [PMID: 27467682 DOI: 10.1002/micr.30087] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Revised: 06/16/2016] [Accepted: 07/08/2016] [Indexed: 11/08/2022]
Abstract
Radial club hand may be congenital or acquired; radial deviation of the hand is usually found, associated with palmar flexion-pronation and treatment of severe forms of radial club hand is often difficult. Here we present a case of reconstruction of a severe postraumatic radial club hand with a free fibular osteoseptocutaneous flap and Sauve-Kapandji procedure in a 28-year-old man. The patient had a radial deviation of the wrist and right upper limb shortening as a result of an infected pseudarthrosis of the radius. This deformity was reconstructed with a free fibular osteoseptocutaneous flap associated to arthrodesis of the distal radioulnar joint and an ulnar resection osteotomy proximal to the arthrodesis in order to restore rotation of the forearm (Sauvé-Kapandji procedure). The flap fully survived and no complications were seen in the early postoperative period at both recipient and donor sites. Radius alignment was restored. At 5-month follow-up, the skeleton was healed. There was minimal osteopenia at the distal radial segment. Wrist extension was 48 degrees, flexion 24 degrees, and pronation-supination was 58-0-48 degrees, with full finger flexion. The patient could hold a 4 kg dumbbell with the elbow flexed without discomfort. His DASH score-Disabilities of the Arm, Shoulder, and Hand Questionnaire was 15.83. Combined free fibular osteoseptocutaneous flap and Sauve-Kapandji procedure may be considered in severe forms of postraumatic radial club hand, however, further data are necessary. © 2016 Wiley Periodicals, Inc. Microsurgery 36:593-597, 2016.
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Affiliation(s)
- Ricardo Horta
- Department of Plastic, Reconstructive and Maxillo-Facial Surgery, and Burn Unity, Centro Hospitalar De São João, Faculty of Medicine, University of Porto, 4202-451, Porto, Portugal. .,Alameda Professor Hernâni Monteiro, Porto, Portugal.
| | - Ricardo Nascimento
- Department of Plastic, Reconstructive and Maxillo-Facial Surgery, and Burn Unity, Centro Hospitalar De São João, Faculty of Medicine, University of Porto, 4202-451, Porto, Portugal.,Alameda Professor Hernâni Monteiro, Porto, Portugal
| | - Alvaro Silva
- Department of Plastic, Reconstructive and Maxillo-Facial Surgery, and Burn Unity, Centro Hospitalar De São João, Faculty of Medicine, University of Porto, 4202-451, Porto, Portugal.,Alameda Professor Hernâni Monteiro, Porto, Portugal
| | - Rui Pinto
- Orthopedic Department, Centro Hospitalar São João, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Pedro Negrão
- Orthopedic Department, Centro Hospitalar São João, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Ricardo São-Simão
- Orthopedic Department, Centro Hospitalar São João, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Jorge Carvalho
- Department of Plastic, Reconstructive and Maxillo-Facial Surgery, and Burn Unity, Centro Hospitalar De São João, Faculty of Medicine, University of Porto, 4202-451, Porto, Portugal.,Alameda Professor Hernâni Monteiro, Porto, Portugal
| | - Marta Santos Silva
- Department of Plastic, Reconstructive and Maxillo-Facial Surgery, and Burn Unity, Centro Hospitalar De São João, Faculty of Medicine, University of Porto, 4202-451, Porto, Portugal.,Alameda Professor Hernâni Monteiro, Porto, Portugal
| | - Jose Amarante
- Department of Plastic, Reconstructive and Maxillo-Facial Surgery, and Burn Unity, Centro Hospitalar De São João, Faculty of Medicine, University of Porto, 4202-451, Porto, Portugal.,Alameda Professor Hernâni Monteiro, Porto, Portugal
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Hu W, Trimaille A, De Vries P, Philandrianos C, Kerfant N. Paediatric distal fibula reconstruction using a pedicled composite second metatarsal flap: a technical note. Injury 2015; 46:2055-8. [PMID: 26243525 DOI: 10.1016/j.injury.2015.07.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Accepted: 07/08/2015] [Indexed: 02/02/2023]
Abstract
The case of a 4-year-old boy in whom a pedicled second metatarsal flap was used for lateral malleolar reconstruction after lawnmower injury is presented. Leg initial assessment demonstrated a 5cm bone loss at the distal fibula combined with severe soft tissue damage. Immediate healing was achieved with split-thickness skin graft but secondary reconstruction was necessary to obtain bone replacement with soft tissue coverage to allow bone growth and shoe donning. To avoid microsurgical fibular epiphyseal transplant morbidity and complications, we used a pedicled second metatarsal flap based on the dorsalis pedis vessels including the second metatarsal bone, the skin of the second toe and the brevis pedis muscle. Repair of the donor side was performed with direct suture and no post-operative course complication was noted. At seven-year follow-up, transferred bone had excellent growth and the patient had adequate ankle function and stable ride. The case provides technique descriptions, considerations in the paediatric population, an overview of other techniques and a seven-year follow-up. It suggests that vascularized chimeric second metatarsal flap may be a useful option in paediatric distal fibula reconstruction.
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Affiliation(s)
- Weiguo Hu
- Service de chirurgie plastique, reconstructrice et esthétique, CHRU de Brest, Boulevard Tanguy Prigent, 29609 Brest cedex, France
| | - Alexandra Trimaille
- Service de chirurgie plastique, reconstructrice et esthétique, CHRU de Brest, Boulevard Tanguy Prigent, 29609 Brest cedex, France
| | - Philine De Vries
- Service de chirurgie pédiatrique, CHRU de Brest, 5 avenue Maréchal Foch, 29609 Brest cedex, France
| | - Cécile Philandrianos
- Service de chirurgie plastique, reconstructrice et esthétique, Assistance Publique des Hôpitaux de Marseille, Hôpital Nord, Chemin des Bourrely, 13015 Marseille, France
| | - Nathalie Kerfant
- Service de chirurgie plastique, reconstructrice et esthétique, CHRU de Brest, Boulevard Tanguy Prigent, 29609 Brest cedex, France.
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