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Vascularized Proximal Fibular Epiphyseal Transfer for Distal Radial Reconstruction
Marco Innocenti, MD1; Luca Delcroix, MD1; Marco Manfrini, MD2; Massimo Ceruso, MD1; Rodolfo Capanna, MD1
1 Division of Hand Surgery and Reconstructive Microsurgery (M.I., L.D., and M.C.); and Department of Orthopaedics, Musculoskeletal Tumor Center (R.C.); Azienda Ospedaliera Careggi, C.T.O., Largo Palagi, 1 50139 Florence, Italy. E-mail address for M. Innocenti: m.innocenti@agora.it
2 Istituto Ortopedico Rizzoli, Via Pupilli 1, I-40136 Bologna, Italy
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The authors did not receive grants or outside funding in support of their research or preparation of this manuscript. They did not receive payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.
Investigation performed at Azienda Ospedaliera Careggi, Florence, and Istituto Ortopedico Rizzoli, Bologna, Italy

The Journal of Bone and Joint Surgery, Incorporated
J Bone Joint Surg Am, 2004 Jul 01;86(7):1504-1511
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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.

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