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.
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
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.
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.