Hand and Microsurgery Unit, Faculty of medicine, Sohag University, Sohag, Egypt.
Lecturer of Orthopedics and Hand surgery, Faculty of medicine, Sohag University, Sohag, Egypt.
Injury. 2023 Dec;54(12):109183. doi: 10.1016/j.injury.2020.11.021. Epub 2020 Nov 17.
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.
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.
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.
Free vascularised proximal fibula bone graft is a new indication for the treatment of an infected distal radius nonunion with a bone defect.
感染性桡骨远端骨不连伴桡腕关节和桡尺远侧关节关节炎的处理被认为是骨科的挑战。尽管已经描述了几种方法，但没有一种方法能提供满意的解决方案。游离腓骨骨移植构成了消除感染、矫正畸形、补偿缩短和维持运动的良好选择。
本研究包括 15 例感染性桡骨远端骨不连伴骨缺损患者。9 例为男性，6 例为女性。患者平均年龄为 20 岁（8-60 岁）。10 例累及右侧腕关节，5 例累及左侧腕关节。9 例由机动车事故引起，4 例由火器伤引起，2 例由高处坠落引起。平均手术次数为 3 次（2-6 次）。治疗原则是清创、切除桡骨远端和修剪桡骨近端至健康出血骨，插入游离带血管腓骨近端骨移植以补偿缺损并固定移植。
15 例中有 13 例手术成功。平均 4 个月后骨愈合。最终随访时无骨髓炎或感染的临床证据。所有病例疼痛完全缓解。腕关节活动度平均屈曲 50°，伸展 45°，手握力与正常部位相同。15 例中有 12 例恢复日常活动。
游离带血管腓骨近端骨移植是治疗感染性桡骨远端骨不连伴骨缺损的新方法。
