Vascularized proximal fibular epiphyseal transfer for bayne and klug type Ⅲ radial longitudinal deficiency in children
10.3760/cma.j.cn114453-20200527-00321
- VernacularTitle:吻合血管的腓骨近端骨骺移植治疗儿童Ⅲ型先天性桡侧纵列缺如
- Author:
Jiantao YANG
1
;
Bengang QIN
;
Wenting HE
;
Honggang WANG
;
Qingtang ZHU
;
Jian QI
;
Liqiang GU
Author Information
1. 中山大学附属第一医院显微创伤手外科，广州 510080
- Keywords:
Proximal fibular;
Epiphyseal transfer;
Inferior lateral genicular artery;
Radial longitudinal deficiency
- From:
Chinese Journal of Plastic Surgery
2020;36(7):729-733
- CountryChina
- Language:Chinese
-
Abstract:
Objective:For Bayne and Klug type Ⅲ radial longitudinal deficiency, the aim of the surgical methods is to create a centralized stable wrist and restore the length of the radius. The purpose of the current study was to validate the use of the staged procedures with vascularized proximal fibular epiphyseal transfer, based on a single vascular pedicle of the inferior lateral genicular artery to treat radius defects.Methods:Between June 2007 and June 2012, five children with an averaged age of 4.3 years (range, 3.3 to 5.8 years) who had a type Ⅲ radial longitudinal deficiency were identified. The staged procedures we performed for this patient consisted of: (1) soft tissue distraction of the wrist with an external distraction device to centralize the wrist and create a space for placement of the proximal fibular graft, ulnar osteotomy, and internal fixation to correct the bowing deformity of the ulna if necessary; (2) vascularized proximal fibular epiphysis transferred to repair the radius defect and to reconstruct the wrist; and (3) pollicization or thumb reconstruction to treat thumb deficiency. In all patients, the range of motion of the digits, wrist, forearm, and elbow; the length of the forearm; and the deviation of the wrist were evaluated.Results:The averaged duration of follow-up was 52.6 months (range, 42 to 72 months). All transplants survived and united with the host bone within 3 months postoperatively. An averaged correction of 28 degrees in the hand-forearm angle was obtained. At the final follow-up, the average ulna and radius lengths were 14.4 cm and 12.1 cm, respectively; the percentage length compared with the normal side was 64.0 and 56.3 percent, respectively. The overall range of wrist motion was approximately 56 percent of that of the contralateral extremity. The averaged pronation and supination were 75 and 45 percent of the normal side, respectively. The overall range of elbow motion was similar to the normal side.Conclusions:The results of the present study indicated that vascularized proximal fibular epiphyseal transfer, based on the inferior lateral genicular artery, is a technically feasible method for treatment of Bayne and Klug type Ⅲ deficiency, which restores the length of the radius and stabilized the wrist.
