Congenital pseudarthrosis of the forearm—Two cases treated by free vascularized fibular graft

Congenital Pseudarthrosis of the Radius Treated With Gradual Distraction and Free Vascularized Fibular Graft: Case Report

“…Among them, 18 were cases of isolated congenital pseudarthrosis of the radius, 1-16 29 of isolated pseudarthrosis of the ulna, 10,14,15,17-21,23, 24,27,28,31,33,34,38 -44 and 20 of congenital pseudarthrosis of both forearm bones. 6,10,14,18,19,[22][23][24]29,30,32,35,38,45,46 FVFG has been reported to be used for the management of congenital pseudarthrosis of the forearm bones in 4 patients with isolated congenital pseudarthrosis of the radius, 10,11,14,15 13 patients with isolated congenital pseudarthrosis of the ulna, 14,15,24,27,28,31,[33][34][35] and 11 patients with congenital pseudarthrosis of both forearm bones. 10,14,24,29,30,32,35 We present a fifth case of isolated congenital pseudarthrosis of the radius with additional longitudinal and angular deformity of the wrist joint, which was managed with FVFG.…”

“…3 This method was most successful when the option of a 1-bone forearm was chosen. 19,23 In 1981, Allieu et al 24,47 reported the treatment of a 4-year-old patient with neurofibromatosis and congenital pseudarthrosis of both forearm bones. After an unsuccessful attempt using internal fixation with plates, union of both forearm bones was accomplished by FVFG for the radius at first and for the ulna a year later.…”

“…After an unsuccessful attempt using internal fixation with plates, union of both forearm bones was accomplished by FVFG for the radius at first and for the ulna a year later. 24 The key to the success of this treatment modality seems to be the combination of wide excision of pseudarthrotic bone and pathological soft tissue envelope and the application of a free graft that brings its own blood supply and has enough length to bridge a large bony defect. In most of the cases, besides bony union, forearm function was adequate as well.…”

“…14,15 Free vascularized fibular graft has been reported to be used with great success in the management of difficult orthopedic problems since 1975. 10,11,14 -16,24 -26 Since the first report of Allieu et al, 24 28 cases of pseudoarthrosis of the radius and/or ulna treated with FVFG have been reported, and all but 1 have led to bone union. 10,11,14,15,24,[27][28][29][30][31][32][33][34][35] The advantages of this method are that it allows aggressive resection of the affected bone and the surrounding pathological tissue, and that it replaces the affected bone with a long vascularized bone with normal healing potential at the proximal and distal ends.…”

Pseudarthrose congénitale de l’avant-bras. À propos de deux cas et revue de la littérature

“…La résection de la zone de pseudarthrose associée à une simple greffe corticospongieuse est souvent vouée à l'échec. La reconstruction des deux os de l'avant-bras ou bien la création d'un avant-bras à un os par transfert de fibula vascularisée, telle qu'elles furent initialement proposées par Allieu et al [2,3], semblent donner les meilleurs résultats. Il convient de classer le type de déformation en fonction de l'étiologie, de sa topographie et de l'état fonctionnel de l'avant-bras afin de pouvoir opter pour un choix thérapeutique adapté.…”