Reconstruction of the Distal Radius

The anterior surgical approach described by Henry is preferably adopted in order to expose the distal radius. In case of tumor resection a variable amount of soft tissue should be included in the resection according to the preoperative planning. The saLVAge of the ulna greatly concurs to improve the final functional outcome.

Sel Poivre Tour Eiffel

Fig. 10D.2. An anterolateral approach is recommended in order to expose the anterior tibial neurovascular bundle. The dissection is carried out in the intermuscular space between tibialis anterior and extensor digitorum longus muscles. The latter, and the peroneus longus are then sharply detached from their proximal insertion in order to dissect the upper part of the pedicle and the fibular epiphysis. An adequate muscular cuff must be preserved around the epiphysis to reduce the risk of damaging the small epiphyseal artery which supplies the growth plate (arrow).

Fig. 10D.2. An anterolateral approach is recommended in order to expose the anterior tibial neurovascular bundle. The dissection is carried out in the intermuscular space between tibialis anterior and extensor digitorum longus muscles. The latter, and the peroneus longus are then sharply detached from their proximal insertion in order to dissect the upper part of the pedicle and the fibular epiphysis. An adequate muscular cuff must be preserved around the epiphysis to reduce the risk of damaging the small epiphyseal artery which supplies the growth plate (arrow).

Due to anatomical similarities, the contralateral fibula is usually preferred in the reconstruction of the distal radius. The bone fixation can be achieved either by plates or lag screws and it is usually facilitated by correspondence in transverse diameter between donor and recipient bones. The wrist joint is temporarily stabilized by a Kirshner wire which will be removed one month after surgery. The strip of biceps femoris tendon is used for soft tissue repair and anchored to the remaining distal radiocarpal capsule. By contrast, the distal radioulnar joint is left lax in order to prevent impingement between fibula and ulna which might interfere with pronosupination.

A reverse flow arterial end to end anastomosis is then performed with the recipient vessel which may be either the radial artery or the common interosseous artery. The selected recipient vein is usually the cephalic vein. At the end of vascular repair bleeding should be observed from both the muscular cuff surrounding the epiphysis and the diaphysis. An above elbow cast is applied during the first month postoperatively.

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