Vascularized metatarsal head transfer to reconstruct the lunate fossa
Elizabeth Anne Killion, MD1; William C. Pederson, MD1; Lindsey White, PA-C2
1Baylor College of Medicine, Houston, TX; 2Texas Children's Hospital, Houston, TX
Purpose: Poorly managed die-punch distal radius fractures represent a difficult problem in that there are limited options for cartilage reconstruction. Current standards of care include total versus partial arthrodesis, which are not ideal a young person who needs to maintain range of motion. Here we present a case of a 16 year-old right hand dominant male who presented with distal radius malunion and cartilage loss within the lunate fossa. He underwent vascularized osseochondral graft from the proximal phalanx of the great toe.
Methods: Using volar and dorsal approaches to the distal radius, dorsal opening wedge osteotomy and iliac crest bone grafting were performed. A volar plate was placed for fixation. We then harvested the vascularized graft from a dorsal incision on the foot. A periosteal pedicle to the joint was identified and traced back to the dorsalis pedis. The vessels to the flap were then anastomosed to the radial artery. Tendon interposition was performed using a toe extensor to decrease donor site morbidity.
Result: At 6 month follow up the patient had minimal pain and range of motion was 60 degrees of volar flexion and 30 degrees of dorsiflexion. X rays indicated bony healing. He was able to ambulate without pain.
Conclusion: The vascularized metatarsal head joint provides a new reconstructive option for cartilage reconstruction of the distal radius. This method relieves pain while preserving range of motion.
A-B. Preoperative CT scan.
C-D Intraoperative findings before and after osteotomies.
E. Donor site planning
F. Pedicle dissection
G. Cartilage on pedicle.
H. Volar plate fixation
I-J. Postoperative images at one month follow up.
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