Epiphyseal Transplant in Distal Radius Reconstruction in Children

Treatment of the loss of the distal 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 achieves both requirements.

Between 1993 and 2002, six patients with a mean age of 7.8 years (range: 6 to 11 years), affected by malignant bone tumor located in the distal radius, underwent microsurgical reconstruction with a vascularized proximal fibular transfer, including the physis and a variable length of the diaphysis. All 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 ulna and the reconstructed radius, and the range of motion of the wrist were evaluated for five of the six patients with 3 years or more of follow-up.

One patient died due to lung metastasis 3 years postoperatively; the remaining five patients are alive and free of disease. The mean follow-up for all six patients was 4.6 years (range: 8 months to 9 years). The six proximal fibula transfers survived and united with the host bone within 2 months postoperatively. The five patients with 3 years or more follow-up have had consistent and predictable longitudinal growth. Serial radiographs have revealed significant remodeling of the articular surface as a consequence of the new loading stresses. The functional results were rated as excellent, except in one case in which the distal ulna was also resected due to neoplastic involvement. No major complication occurred at the recipient site. At the donor site, a peroneal nerve palsy occurred in three patients (50%). This was transient in all cases but one. No knee joint instability was observed.

After radical distal radius resection for neoplasm in children, vascularized proximal fibula transfer based on the anterior tibial artery permits a one-stage skeletal and joint reconstruction, provides excellent function, and minimizes distal radioulnar length discrepancy.