Surgical technique| Volume 45, ISSUE 2, P163.e1-163.e4, February 2020

The Use of a Vascularized Distal Ulna Autograft for Complex Distal Radius Fracture Nonunions

      In patients with segmental nonunion of the distal radius, the distal ulna and distal radioulnar joint may not be salvageable. As an alternative to a vascularized free fibula, a pedicled distal ulna vascularized graft is a useful salvage technique. The procedure relies on the vascular bundle of the pronator quadratus and the dorsal oblique arterial anastomosis between the anterior and posterior interosseous arteries running along the interosseous membrane as the pedicle. We present 3 patients who received a distal ulna vascularized graft with concomitant wrist arthrodesis for distal radius segmental nonunion after complex distal radius fracture. This technique provides a local pedicled graft that may be a simpler, more reliable, and less technically demanding alternative.

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        • Kennedy S.A.
        • Hanel D.P.
        Complex distal radius fractures.
        Orthop Clin North Am. 2013; 44: 81-92
        • Green D.P.
        • Wolfe S.W.
        Green’s Operative Hand Surgery.
        6th ed. Elsevier/Churchill Livingstone, Philadelphia, PA2011
        • Prommersberger K.-J.
        • Fernandez D.L.
        Nonunion of distal radius fractures.
        Clin Orthop Relat Res. 2004; 419: 51-56
        • Houdek M.T.
        • Wagner E.R.
        • Wyles C.C.
        • Nanos G.P.
        • Moran S.L.
        New options for vascularized bone reconstruction in the upper extremity.
        Semin Plast Surg. 2015; 29: 20-29
        • Saremi H.
        • Shahryar-Kamrani R.
        • Ghane B.
        • Yavarikia A.
        Treatment of distal radius fracture nonunion with posterior interosseous bone flap.
        Iran Red Crescent Med J. 2016; 18e38884
        • Germann G.
        • Sauerbier M.
        • Steinau H.U.
        • Wood M.B.
        Reverse segmental pedicled ulna transfer as a salvage procedure in wrist fusion.
        J Hand Surg Br. 2001; 26: 589-592
        • Intuwongse C.S.
        Reconstruction following en bloc resection of a giant cell tumor of the distal radius using a vascularized pedicle graft of the ulna.
        J Hand Surg Am. 1998; 23: 742-747
        • Seradge H.
        Distal ulnar translocation in the treatment of giant-cell tumors of the distal end of the radius.
        J Bone Joint Surg Am. 1982; 64: 67-73
        • Sheetz K.K.
        • Bishop A.T.
        • Berger R.A.
        The arterial blood supply of the distal radius and ulna and its potential use in vascularized pedicled bone grafts.
        J Hand Surg Am. 1995; 20: 902-914
        • Wright T.W.
        • Glowczewskie F.
        Vascular anatomy of the ulna.
        J Hand Surg Am. 1998; 23: 800-804