Vascularized growth plate transfer for distal radius reconstruction

Distal radius reconstruction in children should meet two requests: restoration of some joint function and preservation of the physiologic growth of the segment. None of the conventional options is likely to successfully achieve both goals. Conversely, a vascularized transfer of the proximal fibula including the growth plate provides enough bone stock for diaphyseal reconstruction, an articular surface for joint function, and the potential for longitudinal growth. From 1992 to 2006, eight children ranging in age between 2 and 10 years underwent a vascularized transfer of the proximal fibula for distal radius reconstruction after bone sarcoma resection. The follow-up ranges were between 1 year and 15 years. All the grafts were harvested based on the anterior tibial artery. Seven cases with a follow-up longer than 2 years have been evaluated both clinically and radiographically. All the grafts survived and had a satisfactory growth after the transplant. The functional outcome has been satisfactory, and the range of motion of the reconstructed wrist has been nearly normal in all cases but one. Proximal fibular epiphyseal transfer was an effective procedure for distal radius reconstruction in children who underwent tumor resection. Refinements in the operative technique have increased the reliability of this reconstructive option, which might be safely used also in congenital and posttraumatic disorders.