gms | German Medical Science

Objectives/Interrogation: The use of the third metatarsal allows reconstructing bone and cartilage defects of the distal radius with tissue of similar characteristics, we describe how to optimize the original technique using three-dimensional computer-assisted planning technology.

Methods: A 19-year-old woman referred from another city due to bone and cartilaginous defect of the lunate and sigmoid fossa of the right radius as a sequel to palmar plate removal of the radio six months previously. She presented intense pain with severe limitation of the mobility arches. Using three-dimensional images of the radius and the left foot, the cutting guides are designed to obtain a bone fragment of the third metatarsal to measure the size of the defect, preserving the plantar cortex, unlike the original technique, minimizing the morbidity of the donor area. The free flap of the third metatarsal is raised based on the lateral tarsal branch of the pedius dorsal artery, anastomosed in the recipient bed to the radial vessels and fixed with 1 bicortical screw. No more screws are placed because of the risk of bursting the bone fragment and altering its vascularization. The patient follow up shows improvement of pain, ranges of mobility in progression with physical therapy and without functional limitation of the donor area

Results and Conclusions: The combination of microsurgery techniques and 3D computerized assistance allows to accurately reconstruct defects of high complexity in the upper extremity, providing healthy joint cartilage and sufficient bone support. Arthrodesis is restored. The tools are designed tailored to the patient's defect and allow the simulation of surgery and its possible inconvenience before they occur in the operating room, optimizing the original description of the technique.