Reconstruction of large posttraumatic skeletal defects of the forearm by vascularized free fibular graft

Microsurgery (Impact Factor: 2.42). 01/2004; 24(6):423 - 429. DOI: 10.1002/micr.20067
Source: PubMed
ABSTRACT
Vascularized bone graft is most commonly applied for reconstruction of the lower extremity; indications for its use in the reconstruction of the upper extremity have expanded in recent years. Between 1993–2000, 12 patients with segmental bone defects following forearm trauma were managed with vascularized fibular grafts: 6 males and 6 females, aged 39 years on average (range, 16–65 years). The reconstructed site was the radius in 8 patients and the ulna in 4. The length of bone defect ranged from 6–13 cm. In 4 cases, the fibular graft was harvested and used as a vascularized fibula osteoseptocutaneous flap. To achieve fixation of the grafted fibula, plates were used in 10 cases, and screws and Kirschner wires in 2. In the latter 2 cases, an external skeletal fixator was applied to ensure immobilization of the extremity. The follow-up period ranged from 10–93 months. Eleven grafts were successful. The mean period to obtain radiographic bone union was 4.8 months (range, 2.5–8 months). Fibular grafts allow the use of a segment of diaphyseal bone which is structurally similar to the radius and ulna and of sufficient length to reconstruct most skeletal defects of the forearm. The vascularized fibular graft is indicated in patients with intractable nonunions where conventional bone grafting has failed or large bone defects, exceeding 6 cm, are observed in the radius or ulna. © 2004 Wiley-Liss, Inc. Microsurgery 24:423–429, 2004.

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Available from: Luigi Tarallo
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    • "Therefore, a surgical technique must provide bone stability, stimulate bone repair and reconstitute the original anatomic alignment and length of the forearm bones to regain normal Xexion–extension of the elbow, pronation, supination and grip strength of the wrist. For the most part, treatment has been based on stable plate Wxation combined with either intercalary nonvascularized structural (corticocancellous) bone grafts [7] or vascularized grafts [8, 9]. The latter are typically required for defects larger than 6 cm with the Wbula, being a suitable size match for the bones of the forearm [9] Author's personal copy case of atrophic non-unions, biological enhancement is essential as the cellular and molecular environment of the fracture need to be optimized [10]. "
    [Show abstract] [Hide abstract] ABSTRACT: Clinical study of a series of ten patients treated between 2004 and 2009 for non-unions of the ulna. The patients have been treated with osteosynthesis using a dynamic compression plate and biological enhancement of the consolidation using bone graft and autologous platelet injection. The follow-up consisted of clinical and radiographic assessment. Functional scores used were the Visual Analogue Scale (VAS) for pain and the Disability Assessment for the Shoulder and Hand (DASH) questionnaire. The mean time of follow-up was 21 months. Considering both clinical and radiological criteria, bony union was achieved in 9/10 cases on average time of 4 months. According to the system of Anderson, 5 patients provided an excellent result, 2 a satisfactory result, 2 an unsatisfactory result and 1 treatment resulted in failure. At follow-up, the mean VAS score for pain in the upper limb was 1 (range, 0–4) at rest and 2 (range, 0–7) during activities. The physical function and symptoms of the upper limb, evaluated with the DASH questionnaire, scored 17 points. In conclusion, at a mean 21 months follow-up, there was high success regarding both forearm alignment, clinical and functional results. The use of three combined methods provides high success regarding both radiological and clinical results, even if we have no information on the prevalent efficacy of one particular method.
    Full-text · Article · Dec 2012 · European Journal of Orthopaedic Surgery & Traumatology
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    • "Recommandations générales Nous distinguerons trois situations : l'urgence, l'infection déclarée, le stade séquellaire. En urgence et en urgence différée, il est toujours indiqué de combler la PSO quelle que soit son étendue : @BULLET le raccourcissement n'est pas indiqué ; @BULLET les PSO inférieures à 2 cm relèvent d'une greffe d'interposition monobloc ; @BULLET pour des PSO comprises entre 2 et 5 cm, on s'orientera vers la technique de la membrane induite ; @BULLET les grandes PSO supérieures à 5 cm seront du domaine de la technique de la membrane induite, d'un TOLV [14,15] ou parfois même d'indications exceptionnelles comme le « one bone forearm » [39]. Au fémur : "
    [Show abstract] [Hide abstract] ABSTRACT: La perte de substance osseuse (PSO) diaphysaire est un problème difficile à résoudre en traumatologie en raison notamment des lésions des parties molles et de la fréquence d’une infection associée. Le Symposium 2010 de la Société française de chirurgie orthopédique et traumatologique (Sofcot) a permis de confirmer les conclusions issues d’expériences antérieures isolées. L’étude, rétrospective et multicentrique, a concerné 204 dossiers de PSO diaphysaires des os longs (humérus, radius, ulna, fémur, tibia). Les techniques de reconstruction osseuse étaient les greffes traditionnelles, les transferts vascularisés, les techniques de mobilisation osseuse, la technique de la membrane induite et la technique de Papineau. La consolidation a été acquise dans 93 % des cas, dans un délai moyen de 14,7 mois. Le délai de consolidation n’était pas lié à l’étendue de la perte de substance et était similaire quelle que soit la technique. La technique de la membrane induite, par la simplicité de sa mise en œuvre et son caractère programmé en deux temps en cas d’infection, a été la technique la plus utilisée dans cette série. Les facteurs de mauvais pronostic étaient l’infection, les lésions importantes des parties molles et l’exposition initiale du foyer de fracture. Les grands principes qui gouvernent la reconstruction d’une PSO sont la guérison préalable de l’infection associée et la réparation des parties molles chaque fois que faire se peut. La tendance actuelle est à l’hybridation des procédés de reconstruction en élaborant des stratégies s’appuyant à la fois sur le raccourcissement délibéré, toutes les formes de greffe traditionnelle, la mobilisation osseuse et la membrane induite. Au segment jambier, la greffe intertibiofibulaire doit être considérée comme la clé de voûte de toute reconstruction étendue. Niveau de preuve Niveau IV : étude d’observation rétrospective.
    Full-text · Article · Feb 2012 · Revue de Chirurgie Orthopédique et Traumatologique
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    • "enek gibi görünmekle birlikte son zamanlarda travma sonras› oluflan spesifik durumlarda ve baz› do¤umsal deformitelerde kullan›lmaktad›r. [16,17] Bu teknik, defektin 3 cm'i geçti¤i durumlarda tavsiye edilmemekte ve üst ekstremitede alt ekstremiteyle karfl›laflt›r›ld›¤›nda tekni¤in sinir felci aç›s›ndan için yüksek risk tafl›d›¤› bil- dirilmektedir. [18] Mikrocerrahi tekniklerindeki geliflmeler cerrahlar›n damarl› kemik greftlerinin transferini, atrofik kaynamamalardaki klasik sorunlar›n üstesinden gelmesini sa¤lam›flt›r . Bu tip greftlerin beslenmesi, çevre dokular›n›n damarlanmas›na ve kalitesine ba¤l› de¤ildir. [19] Bu greftler k›r›k bölgesinde damarlanmay› artt›rarak kemik iyileflme"
    Preview · Article · Jan 2012 · acta orthopaedica et traumatologica turcica
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