Background: Treatment of the loss of the distal part of the radius,
including the physis and epiphysis, in a skeletally immature patient requires
both replacement of the osseous defect and restoration of longitudinal growth.
Autologous vascularized epiphyseal transfer is the only possible procedure
that can meet both requirements.
Methods: Between 1993 and 2002, six patients with a mean age of 8.4
years (range, six to eleven years) who had a malignant bone tumor in the
distal part of the radius underwent microsurgical reconstruction of the distal
part of the radius with a vascularized proximal fibular transfer, including
the physis and a variable length of the diaphysis. All of the grafts were
supplied by the anterior tibial vascular network. The rate of survival and
bone union of the graft, the growth rate per year, the ratio between the
lengths of the ulna and the reconstructed radius, and the range of motion of
the wrist were evaluated for five of the six patients who had been followed
for three years or more.
Results: The mean duration of follow-up of the six patients was 4.4
years (range, eight months to nine years). All six transfers survived and
united with the host bone within two months postoperatively. The five patients
who were followed for three years or more had consistent and predictable
longitudinal growth. Serial radiographs revealed remodeling of the articular
surface. The functional result was rated as excellent for all but one patient,
in whom the distal part of the ulna had also been resected because of
neoplastic involvement. No major complication occurred at the recipient site,
whereas a peroneal nerve palsy occurred at the donor site in three patients.
The palsy was transient in two patients, but it persisted in one. No
instability of the knee joint was observed.
Conclusions: After radical resection of the distal part of the
radius because of a neoplasm in children, vascularized proximal fibular
transfer, based on the anterior tibial artery, permits a one-stage skeletal
and joint reconstruction, provides excellent function, and minimizes the
discrepancy between the distal radial and ulnar lengths.
Level of Evidence: Therapeutic study, Level IV (case
series [no, or historical, control group]). See Instructions to Authors for a
complete description of levels of evidence.