gms | German Medical Science

14th Triennial Congress of the International Federation of Societies for Surgery of the Hand (IFSSH), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT)

17.06. - 21.06.2019, Berlin

Fibulo scapho lunate arthrodesis: an option in case of important loss of substance of the distal radius

Meeting Abstract

  • presenting/speaker Simona Odella - ASST Pini-CTO, Milano, Italy
  • Davide Ciclamini - CTO, Torino, Italy
  • Alessandro Crosio - ASST Pini-CTO, Milano, Italy
  • Stefano Bastoni - ASST Pini-CTO, Milano, Italy
  • Primo Daolio - ASST Pini-CTO, Milano, Italy
  • Bruno Battiston - CTO, Torino, Italy
  • Pierluigi Tos - ASST Pini-CTO, Milano, Italy

International Federation of Societies for Surgery of the Hand. International Federation of Societies for Hand Therapy. 14th Triennial Congress of the International Federation of Societies for Surgery of the Hand (IFSSH), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT). Berlin, 17.-21.06.2019. Düsseldorf: German Medical Science GMS Publishing House; 2020. DocIFSSH19-1711

doi: 10.3205/19ifssh1430, urn:nbn:de:0183-19ifssh14309

Published: February 6, 2020

© 2020 Odella et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.


Outline

Text

Objectives/Interrogation: In case of radius trauma, infection or tumour resection, free micro-vascular fibula transfer is considered the established method for the reconstruction. There are different possibilities to reconstruct the radius defect: arthrodesis, this solution provides a good strength and stability but even a complete loss of motion; an alternative could be harvesting the head of the fibula to restore articular surface of the RC joint, this technique is more demanding and it's not able to restore joint stability; the objective is to evaluate the fibula scapho-lunate arthrodesis to understand if it could be a good solution to restore stability and a partial range of motion.

Methods: We used this technique in one case of forearm osteosarcoma, and in three cases of giant cell-tumors showed Campanacci grade 3 lesions, in all patients the fibular graft was based on peroneal artery and vein, the average length was 14,3 cm.

In all cases before positioning the locking plate, we stabilised the scaphoid and the lunate in a correct position compared to the capitate surface using a k-wire, a slot has been created to allow the placement of the fibula between the two carpal bones. After surgery patients were protected in a cast including elbow for 6 weeks and for 2 weeks in a palmar forearm cast.

An x-ray has been performed at 40 days from surgery and after 2 months and 6 months. We evaluated the radiological healing and the ROM at 1 year follow-up.

Results and Conclusions: In literature are reported 16 cases, of these 14 TGC and 2 sarcoma, the mean length of the fibula is 10 cm, the mean ROM is 70 degrees flexion-extension; 130 prono-supination, 6 months to obtain healing at x-ray.

In our patients at 1 year follow-up the mean range of motion was 65° in flexion extension and 120° in prono-supination, the time of healing at x-ray was 6 months from surgery, the mean lemght of the fibula is 14 cm.

No case of instability. Our results are similar to the one referred in literature. The goal of the treatment in case of tumour reconstruction is a one stage procedure that provides secure bony consolidation and allows early physical therapy and further adjuvant therapeutic procedures. We think that the vascularized fibula scapho lunate arthrodesis is a good solution to give stability to the wrist avoiding the complete loss of range of motion. In our experience this procedure is able to restore an adequate function for daily activities, with a high stability associated to a radical wide resection in order to prevent recurrence.