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.
KEYWORDS
Epiphyseal transfer - distal radius reconstruction - bone reconstruction - pediatric microsurgery
REFERENCES
-
1
Innocenti M, Ceruso M, Manfrini M et al..
Free vascularized growth-plate transfer after bone tumor resection in children.
J Reconstr Microsurg.
1998;
14
137-143
-
2
Innocenti M, Delcroix L, Romano G F.
Epiphyseal transplant: harvesting technique of the proximal fibula based on the anterior tibial artery.
Microsurgery.
2005;
25
284-292
-
3
Innocenti M, Delcroix L, Manfrini M et al..
Vascularized proximal fibular epiphyseal transfer for distal radial reconstruction.
J Bone Joint Surg Am.
2005;
87(Suppl 1 Pt 2)
237-246
-
4
Wenger H L.
Transplantation of epiphyseal cartilage.
Arch Surg.
1954;
50
148-151
-
5
Wilson J N.
Epiphyseal transplantation. A clinical study.
J Bone Joint Surg Am.
1966;
48
245-256
-
6
Bowen V, O'Brien B M.
Experimental study of the microsurgical transfer of growth plates.
Can J Surg.
1984;
27
446
-
7
Bowen V.
Experimental free vascularized epiphyseal transplants.
Orthopedics.
1986;
9
893-898
-
8
Donski P K, Carwell G R, Sharzer L A.
Growth in revascularized bone grafts in young puppies.
Plast Reconstr Surg.
1979;
64
239-243
-
9
Donski P K, O'Brien B.
Free microvascular epiphyseal transplantation: an experimental study in dogs.
Br J Plast Surg.
1980;
33
169-178
-
10
Boyer M I, Bray P W, Bowen C V.
Epiphyseal plate transplantation: an historical review.
Br J Plast Surg.
1994;
47
563-569
-
11
Nettelblad H, Randolph M A, Weiland A J.
Physiologic isolation of the canine proximal fibular epiphysis on a vascular pedicle.
Microsurgery.
1984;
5
98-101
-
12
Tsai T M, Ludwig L, Tonkin M.
Vascularized fibular epiphyseal transfer. A clinical study.
Clin Orthop Relat Res.
1986;
210
228-234
-
13
Pho R W, Patterson M H, Kour A K et al..
Free vascularised epiphyseal transplantation in upper extremity reconstruction.
J Hand Surg [Br].
1988;
13
440-447
-
14 Zhong-Wei C, Guang-Jian Z. Epiphyseal transplantation. In: Pho RW Microsurgical Technique in Orthopaedics. London, UK; Butterworths 1988: 121-127
-
15
Bonnel F, Lesire M, Gomis R et al..
Arterial vascularization of the fibula microsurgical transplant techniques.
Anat Clin.
1981;
3
13-23
-
16
Restrepo J, Katz D, Gilbert A.
Arterial vascularization of the proximal epiphysis and the diaphysis of the fibula.
Int J Microsurg.
1980;
2
48-51
-
17
Taylor G I, Wilson K R, Rees M D et al..
The anterior tibial vessels and their role in epiphyseal and diaphyseal transfer of the fibula: experimental study and clinical applications.
Br J Plast Surg.
1988;
41
451-469
-
18 Innocenti M, Ceruso M, Delcroix L. Vascularized epiphyseal transfer in upper limb skeletal reconstruction in children. Indications and operative technique. In: F. Schuind Advances in Upper and Lower Extremity Microvascular Reconstructions. Singapore; World Scientific 2002: 90-101
-
19
Innocenti M, Delcroix L, Manfrini M et al..
Vascularized proximal fibular epiphyseal transfer for distal radial reconstruction.
J Bone Joint Surg Am.
2004;
86
1504-1511
M. InnocentiM.D.
Director, Reconstructive Microsurgery Unit, Department of Orthopaedics
Careggi University Hospital, CTO Largo Palagi 1, 50139, Florence, Italy
