A Treatment Algorithm for Free Vascularized Bone Reconstruction in Rare Large Osseous Defects Involving the Wrist
Abstract
:1. Introduction
2. Materials and Methods
3. Surgical Techniques
3.1. Group 1: Arthrodesis of the Radius and Wrist with Vascularized Bone Flaps
Arthrodesis of the Wrist with Vascularized Fibula Flap for the Treatment of a Large Defect of the Distal Radius
3.2. Group 2: Arthrodesis of the Radius and Metacarpals with Vascularized Bone Flaps
3.2.1. Arthrodesis of the Wrist with Vascularized Iliac Crest Bone
3.2.2. Arthrodesis of the Distal Radius and Middle Hand Using a Triangular-Shaped Vascularized Osteocutaneous Fibula Flap
3.3. Group 3: Arthroplasty of the Proximal Wrist
3.4. Group 4: Fusion of Scaphoid, Lunate, Fibula and Radius (RFSL-Fusion)
4. Results
4.1. Results from Our Own Patient Population
4.2. Results Reported in Previous Studies
4.3. Statistical Analysis of All Four Groups
5. Discussion
5.1. General Results
5.2. Group 1: Arthrodesis of the Radius and Wrist with Vascularized Bone Flaps
5.3. Group 2: Arthrodesis of the Radius and Metacarpals with Vascularized Bone Flaps
5.4. Group 3: Arthroplasty of the Proximal Wrist
5.5. Group 4: Fusion of the Proximal Row of the Wrist with the Distal Radius (RFSL Fusion)
5.6. Limitations of the Study
6. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Localization of the Defect | Pathogenesis | Follow-Up | Age | Defect Lentgh | Graft Type | Reconstruction Concept | Pre-operative ROM Extension/Flexion Pronation/Supination | Post-Operative ROM Extension/Flexion Pronation/Supination | Grip Strength | Quality of Life | Bone Consolidation | ||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|
GROUP 1 | Case 1 | Distal radius, parts of the proximal wrist | Trauma | 6 month | 32 | 9 cm | Vascularized fibula | Wrist arthrodesis | N/A N/A | 0-0-0° 40-0-50° | 60% | MMWS = 50 DASH = 24 | yes |
GROUP 2 | Case 2 | Complete wrist, distal radius and proximal metacarpals | Osteomyelitis | 47 month | 64 | >5 cm | Vascularized iliac crest | Wrist arthrodesis | N/A N/A | 0-0-0° 50-0-35° | 50% | (N/A) | partial |
Case 3 | Complete wrist, distal radius and proximal metacarpals | Benign, aggressive bone tumor | 53 | 41 | 8 cm | Vascularized osteocutaneous triangular fibula | Wrist arthrodesis | N/A N/A | 0-0-0° 80-0-40° | 70% | MMWS = 45 DASH = 30 | yes | |
GROUP 3 | Case 4 | Distal radius involving the radiocarpal surface | Giant cell tumor | 14 | 41 | 8 cm | Vascularized fibula | Wrist arthroplasty | 60-0-50° N/A | 30-0-40° 80-0-70° | 65% | MMWS = 70 DASH = 17 | yes |
GROUP 4 | Case 5 | Distal radius involving the radiocarpal surface | Sarcoma, secondary osteoblastoma | 61 | 20 | 9 | Vascularized fibula | RFSL-Fusion | N/A N/A | 25-0-30 50-0-60 | 70% | MMWS = 65 DASH = 24 | yes |
Case 6 | Distal radius involving the radiocarpal surface | Giant cell tumor | 72 | 45 | 6 | Vascularized fibula | RFSL-Fusion | 60-0-60 70-0-70 | 30-0-30 70-0-50 | 80% | (N/A) | yes | |
Case 7 | Distal radius involving the radiocarpal surface | Giant cell tumor | 25 | 38 | 8 | Vascularized fibula | RFSL-Fusion | 50-0-50 90-0-50 | 40-0-0 80-0-70 | 80% | (N/A) | yes | |
Case 8 | Distal radius involving the radiocarpal surface | Giant cell tumor | 6 | 40 | 7.5 | Vascularized fibula | RFSL-Fusion | 70-0-70 80-0-80 | 30-0-10 50-0-50 | 60% | (N/A) | yes |
Study Type | Patients/Cases | Pathogenesis | Localization of the Defect | Graft Type | Reconstruction Concept | Consolidation | Pre-Operative ROM Extension/Flexion Pronation/Supination | Post-Operative ROM Extension/Flexion Pronation/Supination | Grip Strength | Quality of Life | Level of Evidence | ||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|
GROUP 1 (n = 55) | Ebinger et al., 2003 [8] | Case report | 1 | Failed wrist prothesis | Distal radius | Free vascularized fibula | Arthrodesis | 1/1 | N/A N/A | 0-0-0° 70-0-75° | 85% | N/A | 4 |
Wang et al., 2017 [23] | Cohort study | 27 | Giant cell tumor | Distal radius | Non vascularized iliac crest | Arthrodesis | 21/27 | N/A N/A | N/A Mean 113° | 51% | Musculoskeletal Tumour Society functional classification (MSTS) = 96% DASH = 9 | 4 | |
Clarkson et al., 2013 [24] | Case–control study | 27 | Giant cell tumor | Distal radius | Free vascularized fibula vs. Non vascularized iliac crest | Arthrodesis | 27/27 | N/A N/A | N/A N/A | N/A | MSTS = 90% DASH = 17 | 3 | |
GROUP 2 (n = 4) | Graham et al., 2022 [7] | Case report, Technical note | 2 | Osteomyelitis, Giant cell tumor | Distal radius to proximal middle hand | Vascularized triangular shaped fibula | Arthrodesis | 2/2 | N/A N/A | N/A N/A | N/A | N/A | 4 |
Inui et al., 2020 [20] | Case report | 2 | Osteomyelitis | Carpus | Non vascularized induced membrane technique | Arthrodesis | 1/2 | N/A N/A | N/A N/A | 80% | N/A | 4 | |
GROUP 3 (n = 82) | Mays et al., 2010 [10] | Case report | 1 | Giant cell tumor | Distal radius and proximal row | Free vascularized fibula head | Arthroplasty | 1/1 | N/A N/A | 35-0-45° N/A | 80% | N/A | 4 |
Saini et al., 2011 [25] | Cohort study | 12 | Giant cell tumor | Distal radius | Non vascularized fibula head | Arthroplasty | 9/12 | N/A N/A | 31-0-42° 37-0-52° | 71% (42–86%) | MSTS = 91% | 4 | |
Chung et al., 2013 [12] | Cohort study | 12 | Giant cell tumor | Distal radius | Free vascularized fibula head | Arthroplasty | 12/12 | N/A N/A | Mean 73° Mean 102.9° | 57.3% | N/A | 4 | |
Scaglioni et al., 2014 [2] | Case series | 3 | Giant cell tumor, osteosarcoma | Distal radius | Free vascularized fibula head | Arthroplasty | 3/3 | N/A N/A | 32-0-72° 83-0-38° | N/A | N/A | 4 | |
Yang et al., 2016 [16] | Cohort study | 17 | Giant cell tumor | Distal radius | Free vascularized fibula head | Arthroplasty | 17/17 | N/A N/A | 52-0-49° N/A | 77.2° | MMWS = 77.3 | 4 | |
Liu et al., 2019 [6] | Cohort study | 26 | Giant cell tumor | Distal radius | Free vascularized fibula head | Arthroplasty | 26/26 | 44-0-52° 42-0-45° | 32-0-42° 22-0-31° | 71% | DASH = 33.3 | 4 | |
Barik et al., 2020 [19] | Cohort study | 11 | Giant cell tumor | Distal radius | Non vascularized fibula head | Arthroplasty | 11/11 | N/A N/A | 47-0-37° 64-0-57° | 51% | MMWS = 66.4 | 4 | |
GROUP 4 (n = 3) | Franz et al., 2010 [1] | Case report | 1 | Giant cell tumor | Distal radius | Free vascularized fibula | RFSL-Fusion | 1/1 | 30-0-40° N/A | 40-0-20° 70-0-80° | 75% | N/A | 4 |
Bickert et al., 2002 [26] | Case series | 2 | Giant cell tumor | Free vascularized fibula | RFSL-Fusion | 2/2 | N/A N/A | 22.5-0-35° 62.5-0-70° | 64.5% | N/A | |||
GROUP 1 vs. 3 (n = 21) | Qu et al., 2019 [18] | Case–control study | 21 | Giant cell tumor | Distal radius | Non vascularized fibula head | Arthroplasty (n = 13) vs. Total wrist arthrodesis (n = 8) | 20/21 | N/A N/A | N/A N/A | 40% (n = 13) vs. 71% (n = 8) | MSTS = 93% vs. 83% | 3 |
GROUP 3 vs. 4 (n = 14) | Zhu et al., 2013 [27] | Case–control study | 14 | Giant cell tumor | Distal radius | Vascularized and non-vascularized proximal fibula | Arthroplasty (n = 7) vs. partial wrist arthrodesis (n = 7) | 14/14 | N/A N/A |
71.6 ± 16.1° vs.
55.9 ± 7.5°
140 ± 14.7° vs. 127.6 ± 14.2° |
59.2
± 13.7% vs. 76.5 ± 4.6% | MSTS =
25.9 ± 1.46
vs. 25.6 ± 0.78 | 3 |
NO GROUP | Wood et al., 2006 [28] | Expert opinion | N/A | various | various | various | various | N/A | N/A N/A | N/A N/A | N/A | N/A | 5 |
Malizos et al., 2010 [9] | Review, expert opinion | N/A | various | various | various | various | N/A | N/A N/A | N/A N/A | N/A | N/A | 5 | |
Liu et al., 2021 [5] | Review | N/A | various | various | various | various | N/A | N/A N/A | N/A N/A | N/A | N/A | 4 |
Group | Frequency | Valid Percent | ROM (Mean) Extension/Flexion | ROM (Mean) Pronation/Supination | DASH (Mean) | MMWS (Mean) |
---|---|---|---|---|---|---|
1 | 56 | 36.842% | 0° | 113.31° ± 7.44° | 13.20 ± 4.26 | 55 ± N/A |
2 | 6 | 3.947% | 0° | 102.50° ± 24.75° | 30.00 ± N/A | 45 ± N/A |
3 | 83 | 54.605% | 88.56° ± 11.71° | 85.02° ± 28.79° | 32.41 ± 3.08 | 72.59 ± 5.40 |
4 | 7 | 4.605% | 53.00° ± 9.04° | 128.00° ± 19.11° | 24.00 ± N/A | 65 ± N/A |
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Thiel, J.T.; Bamberg, M.; Daigeler, A.; Fontana, J.; Hoffmann, S.; Illg, C.; Kolbenschlag, J.; Steiner, D.; Lauer, H. A Treatment Algorithm for Free Vascularized Bone Reconstruction in Rare Large Osseous Defects Involving the Wrist. Life 2024, 14, 1099. https://doi.org/10.3390/life14091099
Thiel JT, Bamberg M, Daigeler A, Fontana J, Hoffmann S, Illg C, Kolbenschlag J, Steiner D, Lauer H. A Treatment Algorithm for Free Vascularized Bone Reconstruction in Rare Large Osseous Defects Involving the Wrist. Life. 2024; 14(9):1099. https://doi.org/10.3390/life14091099
Chicago/Turabian StyleThiel, Johannes Tobias, Maximilian Bamberg, Adrien Daigeler, Johann Fontana, Sebastian Hoffmann, Claudius Illg, Jonas Kolbenschlag, Dominik Steiner, and Henrik Lauer. 2024. "A Treatment Algorithm for Free Vascularized Bone Reconstruction in Rare Large Osseous Defects Involving the Wrist" Life 14, no. 9: 1099. https://doi.org/10.3390/life14091099