J Wrist Surg 2016; 05(02): 160-164
DOI: 10.1055/s-0036-1581051
Wrist and Carpal Anatomy
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Distal Ulna Reconstruction using the Second Metatarsal: Anatomical Study

Pedro C. Cavadas
1   Reconstructive Surgery, Clinica Cavadas, Valencia, Spain
,
Alessandro Thione
1   Reconstructive Surgery, Clinica Cavadas, Valencia, Spain
,
Isabel Elía Martinez
2   Department of Diagnostic Imaging, Hospital de Manises, Valencia, Spain
› Author Affiliations
Further Information

Publication History

30 December 2015

14 February 2016

Publication Date:
29 March 2016 (online)

Abstract

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.

 
  • References

  • 1 Shaaban H, Giakas G, Bolton M, Williams R, Scheker LR, Lees VC. The distal radioulnar joint as a load-bearing mechanism—a biomechanical study. J Hand Surg Am 2004; 29 (1) 85-95
  • 2 Hagert CG. The distal radioulnar joint in relation to the whole forearm. Clin Orthop Relat Res 1992; 275 (275) 56-64
  • 3 Hagert CG. The distal radioulnar joint. Hand Clin 1987; 3 (1) 41-50
  • 4 Tulipan DJ, Eaton RG, Eberhart RE. The Darrach procedure defended: technique redefined and long-term follow-up. J Hand Surg Am 1991; 16 (3) 438-444
  • 5 Bieber EJ, Linscheid RL, Dobyns JH, Beckenbaugh RD. Failed distal ulna resections. J Hand Surg Am 1988; 13 (2) 193-200
  • 6 Berger RA. Implant arthroplasty for treatment of ulnar head resection-related instability. Hand Clin 2013; 29 (1) 103-111
  • 7 Garcia-Elias M. Eclypse: partial ulnar head replacement for the isolated distal radio-ulnar joint arthrosis. Tech Hand Up Extrem Surg 2007; 11 (1) 121-128
  • 8 Zimmerman RM, Kim JM, Jupiter JB. Arthritis of the distal radioulnar joint: from Darrach to total joint arthroplasty. J Am Acad Orthop Surg 2012; 20 (10) 623-632
  • 9 Sharma A, Kumar A, Singh P. Anatomical study of the distal end of cadaveric human ulnae: a clinical consideration for the management of distal radioulnar joint injuries. Singapore Med J 2011; 52 (9) 673-676
  • 10 Chen YR, Tang JB. In vivo gliding and contact characteristics of the sigmoid notch and the ulna in forearm rotation. J Hand Surg Am 2013; 38 (8) 1513-1519
  • 11 Cavadas PC, Landin L, Thione A. Reconstruction of the condyles of the proximal phalanx with osteochondral grafts from the ulnar base of the little finger metacarpal. J Hand Surg Am 2010; 35 (8) 1275-1281
  • 12 del Piñal F, Klausmeyer M, Moraleda E , et al. Vascularized graft from the metatarsal base for reconstructing major osteochondral distal radius defects. J Hand Surg Am 2013; 38 (10) 1883-1895
  • 13 del Piñal F, Guerrero-Navarro ML, Studer A, Thams C, Moraleda E. Reconstruction of the ulnar head with a vascularized second metatarsal head: case report. J Hand Surg Am 2012; 37 (8) 1568-1573
  • 14 Hamada N, Ikuta Y, Ikeda A. Arteries to the great and second toes based on three-dimensional analysis of 100 cadaveric feet. Surg Radiol Anat 1993; 15 (3) 187-192
  • 15 Gu YD, Zhang GM, Chen DS, Cheng XM, Xu JG, Wang H. Vascular anatomic variations in second toe transfers. J Hand Surg Am 2000; 25 (2) 277-281
  • 16 Alagoz MS, Orbay H, Uysal AC, Comert A, Tuccar E. Vascular anatomy of the metatarsal bones and the interosseous muscles of the foot. J Plast Reconstr Aesthet Surg 2009; 62 (9) 1227-1232
  • 17 Loh JS, Lim BH, Wan CT, Tan SH. Second metatarsophalangeal joint: biomechanics and reconstruction potential. Clin Orthop Relat Res 2004; (421) 199-204
  • 18 Lim BH, Loh SY. Reconstruction of a posttrauma arthritic distal radioulnar joint by vascularized second metatarsophalangeal joint transfer. Plast Reconstr Surg 2006; 117 (2) 19e-23e