Bone reconstruction with vascularized free fibula in the treatment of osteomyelitis of the distal radius: a case series

Background Osteomyelitis of the distal radius and wrist with bone defect presents a reconstructive challenge. Free fibula grafts have been successfully used in post tumor resection reconstruction of the wrist. Methods We applied these techniques to the reconstruction of wrist adjacent osteomyelitis associated bone defects and report on the feasibility of the technique in this context. We retrospectively evaluated 4 patients treated from January 2009 to February 2017 with a free fibular osteocutaneous flap for distal radius osteomyelitis. Previous operations, defect size, time of operation, type of fixation, complete bone union, and functional outcomes were assessed. Results The mean age at surgery was 45.8 years (range 37-60 years). The mean operation time was 430 min (range: 350-570 min). The ulnar head was removed in all patients. The average time to complete bony consolidation was 8 months. Three of the patients were pain-free at rest, and one had a remaining pain rated as VAS 2-3. The average grip strength was 23.6 kg. Conclusions The use of vascularized fibular grafts for the reconstruction of the distal radius appears to be a reliable solution with satisfactory clinical results. It has the advantage of restoring the continuity of the forearm and wrist in one step using vital bone tissue, which is more resistant to infection than a non-vascularized graft.