JORT Journal

Abstract

Introduction: vascularized fibula epiphysis transfer are complex surgical techniques and indications are restricted in the aim of child’s joint reconstruction with significant residual growth potential. The literature is poor. The goal of this study is to evaluate the remodelling of the neo-joints after the graft and to quantify transplant’s growth. Materials and methods: This are a mono-centric retrospective study including 4 patients. Mean age at surgery was 7 years, 10 months, (min 56 months, max 11 years). The indications included sarcoma, infection or trauma. The transplant’s residual growth potential at the time of surgery was calculated using the Paley Growth Predictions^® app. The analysis of the pre and post-operative radiological data allowed the measurement of flap’s growth compared to its healthy side and the evaluation of its morphological adaptation to the recipient site. The reconstruction involved 1 hip, 1 shoulder, 1 wrist and 1 ankle. Results: Concerning the hip, transplant’s metaphysis progressed to 136% growth. The reconstruction of lateral malleolus has a growth in length of +4.6 cm in 3 years, similar to the ipsilateral ankle. The LDTA was 79° on the operated side versus 83° on the contralateral side, which is not significant and testifies to the restoration of the ankle axes. About the distal radius, we estimated that the transfer grew by 3.93 cm. The remodelling of the new humeral head is most evident as it becomes convex at 180°. The diameter of the neo-humeral head was 2.2 cm versus 5.4 cm on the contralateral side, or 41%. Diaphysis’s growth charts were generally similar but with a difference in length in favor of the healthy limb, the width of the shaft was 10.5 mm versus 18 mm, or 58%. Discussion: This technique is highly demanding and requires that one of the major arteries of the leg be sacrificed. Epiphyseal remodelling allowed recovery of joint amplitudes, which is notoriously significant. Transplant length growth’s is globally identical to that of the non-operated limb. Our work remains in agreement with the publications on the subject even if the values found on the growth of the transplant are lower than those reported. Conclusion: Joint remodelling of the transfer provides hope that the recovery of joint function will be better than with other treatment options, especially when the child is younger. A longer-term analysis is needed to evaluate and compare the function of these newly formed joints using specific questionnaires.