Pseudarthrosis of the radius treated by free vascularised bone graft

Abstract

We report a case of pseudarthrosis of the radius successfully treated by free vascularised bone grafting. After a comprehensive review of the literature, we recommend this as the treatment of choice in this condition. We also report the use of callus distraction of an incorporated vascularised bone graft to achieve bone lengthening.

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.…”

“…Eighteen patients with isolated congenital radial pseudarthrosis have been reported (Table 1). [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16] Of these, only 4 were treated with free vascularized fibular graft (FVFG).…”

“…14 Many treatment modalities and different surgical procedures have been described for the treatment of congenital pseudarthrosis of the radius. Cast immobilization, 1,2,4,7,10,[17][18][19] corticocancellous autologous grafting, 3,5,6,20,21 intramedullary nailing, 6,8,22 electrical stimulation, 7,11 and cross-union of forearm bones 14,19,23 have not reproducibly achieved bony union. 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. 36 Mathoulin et al 14 were the only authors who used preoperative gradual distraction of the pseudarthrosis site in conjunction with the use of FVFG.…”

Surgical treatment of aseptic forearm nonunion with plate and opposite bone graft strut. Autograft or allograft?

“…Conversely, in the atrophic forms, the goal must be the restoration of a good biological environment [20]. Various surgical techniques have been proposed for treatment of forearm nonunions [21][22][23][24][25][26][27][28][29][30][31][32][33][34][35]. Shelton and Sage reported an union rate of 87 % using a compression plate and iliac graft [33].…”