Highlights
- •In infected distal radius non-union with a bone defect free vascularised fibula bone graft constitutes a good option to eradicate the infection, correct the deformity, compensate for the shortening and maintain motion.
- •The procedure was successful in 13 of 15 cases with bone union being achieved at an average of 4 months.
- •Wrist joint range of motion averaged flexion 50°, extension 45° and handgrip was the same as the normal site.
- •Pain was completely relieved in all cases.
Abstract
Objective
Management of infected distal radius nonunion with a bone defect and radiocarpal and
distal radio-ulnar joint arthritis is considered an orthopaedic challenge. Although
several methods have been described but none provide a satisfactory solution. Free
vascularised fibula bone graft constitutes a good option to eradicate the infection,
correct the deformity, compensate for the shortening and maintain motion.
Material and methods
This study included 15 cases with infected distal radius nonunion associated with
bone defects. Nine cases were males and six were females. The average age of the patient
was 20 years (range 8 - 60 years). The right wrist was involved in 10 patients and
left was affected in 5 patients. Nine cases resulted from a motor vehicle accident,
four cases after a firearm injury and two cases due to falling from a height. The
average number of previous surgical procedures was three (range 2 -6). The principle
of treatment was debridement, excision of distal radius and trimming of the proximal
part of radius back to healthy bleeding bone, inserting the free vascularised proximal
fibular bone graft to compensate the defect and fixation of the graft.
Results
The procedure was successful in 13 of 15 cases. Bone union was achieved at an average
of 4 months. No clinical evidence of osteomyelitis or or infection at final follow-up.
Pain was completely relieved in all cases. Wrist joint range of motion averaged flexion
50˚, extension 45˚ and handgrip was the same as the normal site. Twelve cases out
of 15 returned to their daily activities.
Conclusion
Free vascularised proximal fibula bone graft is a new indication for the treatment
of an infected distal radius nonunion with a bone defect.
Keywords
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Article info
Publication history
Published online: November 16, 2020
Accepted:
November 8,
2020
Publication stage
In Press Journal Pre-ProofFootnotes
☆This paper is part of a Supplement supported by the European Federation of Societies of Microsurgery (EFSM).
Identification
Copyright
© 2020 Published by Elsevier Ltd.
