Some problems in wrist reconstruction after tumor resection with vascularized fibular-head graft

Restoration of wrist function was attempted in six patients with aggressive or malignant bone tumor of the distal end of the radius with free vascularized fibular graft including the fibular head, and following wide resection of tumor. There was no local recurrence in all six cases. In one case, pulmonary metastasis occurred, but was successfully treated. Secondary bone graft was necessary in two cases for non-union. Additional procedures, such as partial or total wrist fusion, were necessary in three cases due to collapse of the grafted fibular head. Corrective osteotomy or a Sauve-Kapandji procedure were also needed in two cases for improvement of forearm rotation. Grip strength ranged from 41 to 68 percent of the contralateral side, with an average of 54.6 percent in five cases; it was only 6 percent in one patient because of flexion contracture at the wrist joint. Final functional results, evaluated by a modified system of Enneking, ranged from 73 to 92 percent, with an average of 83.2 percent. Indications for this procedure seem to be limited to patients engaged in non-heavy manual work, in whom the proximal carpal row can be preserved during tumor resection, and who have given consent for additional secondary procedures, if they prove necessary.