Albuquerque Maria, Mata Ribeiro Luís, Botton Miguel
Serviço de Cirurgia Plástica e Reconstrutiva do Centro Hospitalar Universitário Lisboa Central, Portugal.
Serviço de Cirurgia Plástica e Reconstrutiva do Centro Hospitalar Universitário Lisboa Central, Portugal.
Int J Surg Case Rep. 2024 Nov;124:110447. doi: 10.1016/j.ijscr.2024.110447. Epub 2024 Oct 11.
Distal radius fractures are common among adults. Despite being a rare complication, occurring in only 0.2 % of the cases, non-union poses significant treatment challenges.
In this article, we report the case of a 43-year-old male with a history of distal radius fracture resulting from a motorcycle accident. His initial treatment consisted of external fixation followed by a distraction plate and internal fixation with volar plate and screws. Due to plate breakage, he underwent refixation with a volar plate and autologous bone graft six months after the accident. However, five months after surgery, CT-scans showed a radius non-union. This led to a multidisciplinary approach involving orthopaedic and plastic surgery teams, where the patient underwent distal radius reconstruction using a free fibula flap. Postoperative recovery led to favourable outcomes with evidence of bony consolidation at six-month follow-up.
Conventional techniques for distal radius non-union treatment may fall short in achieving bony continuity in a non-suitable soft tissue environment. Free vascularised fibular flap has emerged as a primary option for long bone reconstruction, offering advantages such as anatomical compatibility and immediate structural support.
This case highlights the efficacy of free fibular flap in addressing complex distal radius non-unions, providing an effective solution when simpler techniques have failed.
桡骨远端骨折在成年人中很常见。骨不连虽是一种罕见的并发症，仅发生于0.2%的病例中，但却带来了重大的治疗挑战。
在本文中，我们报告了一例43岁男性患者，其有因摩托车事故导致桡骨远端骨折的病史。他最初的治疗包括外固定，随后采用牵引钢板以及掌侧钢板和螺钉进行内固定。由于钢板断裂，事故发生六个月后，他接受了掌侧钢板和自体骨移植的再次固定。然而，术后五个月，CT扫描显示桡骨骨不连。这导致了一个涉及骨科和整形外科团队的多学科治疗方案，患者接受了使用游离腓骨瓣的桡骨远端重建手术。术后恢复取得了良好的效果，六个月随访时有骨愈合的证据。
桡骨远端骨不连的传统治疗技术在不合适的软组织环境中可能无法实现骨连续性。带血管蒂游离腓骨瓣已成为长骨重建的主要选择，具有解剖学相容性和即时结构支撑等优点。
本病例突出了游离腓骨瓣在处理复杂桡骨远端骨不连方面的疗效，在更简单的技术失败时提供了一种有效的解决方案。
