Two-Stage Reconstruction of Congenital Pseudarthrosis of the Forearm

The treatment of congenital pseudarthrosis of the forearm is a major problem in reconstructive surgery. The free vascularized fibula graft is an excellent choice to overcome the limitations of conventional methods in the reconstruction of congenital pseudarthrosis of the forearm. The aim of this paper was to present clinical experience of treatment of congenital pseudarthrosis of the forearm by free vascularized fibula osteoseptocutaneous grafts in two stages with an Ilizarov device application. The main point of a two-stage reconstruction is that free vascularized fibula graft transplantation is used after lengthening of the forearm to normal size and elimination of deformity.

The authors'clinic has the experience of reconstruction in 9 patients with congenital pseudarthrosis of the forearm, who were operated on between 1986 and 2003. Eight patients were male and one female, with a mean age of 12 years (range 6–18). Three types of congenital pseudarthrosis of the forearm were observed: type 1-congenital pseudarthrosis of radial bone; type 2-congenital pseudarthrosis of radial and ulna bones in the middle part; type 3-congenital pseudarthrosis of radial and ulna bones with neurofibromatosis of the radial bone proximal part and ulna bone distal part.

The reconstruction was done in two stages. At the first stage, the authors applied the Ilizarov device to the forearm to lengthen the forearm and eliminate deformity. At the second stag,e the forearm bone defect was reconstructed using a free fibula vascularized graft. The maximum lengthening of the forearm was 1 mm per day. All patients had complete survival of the transferred fibula graft with consolidation 5–7 months after fibula graft transfer.

The two-stage method of reconstruction of congenital pseudarthrosis of the forearm is very effective. There are two main advantages. The application of the Ilizarov device allows for safe active movements during the whole treatment–this is the first advantage. The exact size of the bone defect can be defined when lengthening with an Ilizarov device–this is the second advantage.