Cuboid Bone for Distal Radius Reconstruction: An Anatomical Cadaver Study

Abstract

Background The cuboid bone (CB) of the foot has been suggested as a potential source of autologous reconstruction of the distal radius (DR). This study sought to examine the feasibility of harvesting the CB as a vascularized bone transfer for DR reconstruction.

Purposes We evaluated the feasibility of a vascularized bone transfer of the CB by performing the flap dissection, analyzing its pedicle and demonstrating its perfusion using indocyanine green (ICG) fluorescence angiography.

Materials and Methods Ten feet from five fresh-frozen cadaver specimens were dissected. The lateral tarsal artery (LTA) mean diameter, length, and emerging point were described. The CB mean length and the mean length of the bone segment harvested were reported. ICG injection was used to demonstrate its blood supply.

Results The average length of the pedicle was 68.26 ± 3.12 mm. The mean diameter was 1.43 ± 0.15 mm. The CB had a mean anterior–posterior length of 40.81 ± 5.05 mm. The harvested bone had a mean length of 15.05 ± 2.03 mm. All CBs showed enhancement after ICG injection.

Conclusion The CB presented reasonable anatomical similarities with the DR and a long and consistent pedicle with an adequate blood supply observed during ICG injection.

Clinical Relevance This study supports the possibility of using the CB as a vascularized bone transfer for autologous reconstruction of the articular surface of the DR. Further study is warranted.

Keywords

distal radius reconstruction - cuboid bone flap - distal radioulnar joint - reconstructive surgery - microsurgery

Publikationsverlauf

Eingereicht: 24. November 2023

Angenommen: 12. März 2024

Artikel online veröffentlicht:
16. April 2024

• References

• 1 Hagert CG. The distal radioulnar joint. Hand Clin 1987; 3 (01) 41-50
• 2 Haugstvedt JR, Langer MF, Berger RA. Distal radioulnar joint: functional anatomy, including pathomechanics. J Hand Surg Eur Vol 2017; 42 (04) 338-345
• 3 Harness NG, Mankin HJ. Giant-cell tumor of the distal forearm. J Hand Surg Am 2004; 29 (02) 188-193
• 4 Khan MT, Gray JM, Carter SR, Grimer RJ, Tillman RM. Management of the giant-cell tumours of the distal radius. Ann R Coll Surg Engl 2004; 86 (01) 18-24
• 5 O'Neill TW, Cooper C, Finn JD. et al; UK Colles' Fracture Study Group. Incidence of distal forearm fracture in British men and women. Osteoporos Int 2001; 12 (07) 555-558
• 6 Kong L, Fu M, Lu J, Zhou Y, Zhang Z, Zhang B. The effect of distal radius fractures involving the distal radioulnar articular joint on forearm rotation. J Orthop Surg Res 2020; 15 (01) 548
• 7 Kong L, Zhai Y, Zhang Z, Lu J, Zhang B, Tian D. Radiocarpal joint stiffness following surgical treatment for distal radius fractures: the incidence and associated factors. J Orthop Surg Res 2020; 15 (01) 313
• 8 Bianchi G, Donati D, Staals EL, Mercuri M. Osteoarticular allograft reconstruction of the distal radius after bone tumour resection. J Hand Surg [Br] 2005; 30 (04) 369-373
• 9 Szabo RM, Anderson KA, Chen JL. Functional outcome of en bloc excision and osteoarticular allograft replacement with the Sauve-Kapandji procedure for Campanacci grade 3 giant-cell tumor of the distal radius. J Hand Surg Am 2006; 31 (08) 1340-1348
• 10 Chung DW, Han CS, Lee JH, Lee SG. Outcomes of wrist arthroplasty using a free vascularized fibular head graft for Enneking stage II giant cell tumors of the distal radius. Microsurgery 2013; 33 (02) 112-118
• 11 Zoccali C, Formica VM, Sperduti I. et al. Wide resection for giant-cell tumor of the distal radius: which reconstruction? A systematic review of the literature and pooled analysis of 176 cases. Hand Surg Rehabil 2022; 41 (05) 552-560
• 12 Bianchi G, Sambri A, Marini E, Piana R, Campanacci DA, Donati DM. Wrist arthrodesis and osteoarticular reconstruction in giant cell tumor of the distal radius. J Hand Surg Am 2020; 45 (09) 882.e1-882.e6
• 13 Kuruoglu D, Rizzo M, Rose PS, Moran SL, Houdek MT. Treatment of giant cell tumors of the distal radius: a long-term patient-reported outcomes study. J Surg Oncol 2022; 126 (04) 798-803
• 14 Qu H, Guo W, Li D, Yang Y, Wei R, Xu J. Functional results of wrist arthrodesis versus arthroplasty with proximal fibula following giant cell tumour excision of the distal radius. J Hand Surg Eur Vol 2019; 44 (04) 394-401
• 15 Liu W, Wang B, Zhang S, Li Y, Hu B, Shao Z. Wrist reconstruction after en bloc resection of bone tumors of the distal radius. Orthop Surg 2021; 13 (02) 376-383
• 16 Muangsiri P, Tanjapatkul R, Sriswadpong P, Jomkoh P, Jirawatnotai S. Indocyanine green fluorescence angiography of the transverse cervical arterial supply to clavicle flaps: an anatomical study. Otolaryngol Head Neck Surg 2022; 166 (01) 68-73
• 17 Bai L, Peng YB, Liu SB, Xie XX, Zhang XM. Anatomical basis of a pedicled cuboid bone graft based on the lateral tarsal artery for talar avascular necrosis. Surg Radiol Anat 2021; 43 (10) 1703-1709
• 18 Pountos I, Panteli M, Giannoudis PV. Cuboid injuries. Indian J Orthop 2018; 52 (03) 297-303
• 19 Weber M, Locher S. Reconstruction of the cuboid in compression fractures: short to midterm results in 12 patients. Foot Ankle Int 2002; 23 (11) 1008-1013
• 20 Yu G, Yu T, Yang Y, Li B, Yuan F, Zhou J. Nutcracker fracture of the cuboid: management and results. Acta Orthop Belg 2012; 78 (02) 216-219
• 21 Pho RW. Free vascularised fibular transplant for replacement of the lower radius. J Bone Joint Surg Br 1979; 61-B [phone]
• 22 Onoda S, Sakuraba M, Asano T. et al. Use of vascularized free fibular head grafts for upper limb oncologic reconstruction. Plast Reconstr Surg 2011; 127 (03) 1244-1253
• 23 Muller C, Athlani L, Barbary S, Dautel G. Reconstruction of the distal radius using a double-barrel vascularized fibula flap: a case series. Hand Surg Rehabil 2022; 41 (02) 189-193
• 24 Aldekhayel S, Govshievich A, Neel OF, Luc M. Vascularized proximal fibula epiphyseal transfer for distal radius reconstruction in children: a systematic review. Microsurgery 2016; 36 (08) 705-711
• 25 Mericli AF, Asaad M, Lewis VO. et al. Free fibula flap for extremity oncologic defects: factors influencing union and functional outcomes. Plast Reconstr Surg 2023; 151 (04) 885-896
• 26 del Piñal F, Guerrero-Navarro ML, Studer A, Thams C, Moraleda E. Reconstruction of the ulnar head with a vascularized second metatarsal head: case report. J Hand Surg Am 2012; 37 (08) 1568-1573
• 27 Cavadas PC, Thione A, Martinez IE. Distal ulna reconstruction using the second metatarsal: anatomical study. J Wrist Surg 2016; 5 (02) 160-164
• 28 Cavadas PC, Thione A. Ulnar head reconstruction with microvascular second metatarsal. Plast Reconstr Surg Glob Open 2017; 5 (04) e1284
• 29 Cavadas PC, Padial B. Radiocarpal joint reconstruction with a double free metatarsophalangeal joint transfer. Plast Reconstr Surg Glob Open 2023; 11 (09) e5284