Reconstruction of Congenital Pseudarthrosis of the Radius Using a Vascularized Tibial Periosteum Transplant: A Case Report
Article Sidebar
Published:
Feb 24, 2025
Keywords:
Vascularized periosteum, congenital pseudarthrosis, reconstruction, flaps, neurofibromatosis
Main Article Content
Abstract
Congenital pseudarthrosis of the radius is a rare condition, commonly associated with neurofibromatosis or fibrous dysplasia. We present the first reported case of using a vascularized periosteal flap for the treatment of congenital pseudarthrosis of the radius. The patient was a 14-month-old boy with neurofibromatosis type 1, presenting with severe shortening of the forearm, radial deviation of the wrist, and limitation of pronation-supination (60°-80°). Radiographs revealed pseudarthrosis in the distal third of the right radius. Surgical treatment involved debridement, bone fixation with a Kirschner wire, and placement of a vascularized periosteal flap harvested from the contralateral tibia to cover the pseudarthrosis site. Radiographic evidence of callus formation was observed two weeks postoperatively, accompanied by full wrist flexion-extension and improved pronation-supination (90°-90°). At five weeks, the patient resumed activities without orthotic protection. The use of vascularized tibial periosteum represents an innovative approach for treating congenital pseudarthrosis of the radius, demonstrating rapid bone healing and early return to activity, with no morbidity at the donor site.
Downloads
Download data is not yet available.
Metrics
Metrics Loading ...
Article Details
How to Cite
Saralegui, P., & Soldado, F. (2025). Reconstruction of Congenital Pseudarthrosis of the Radius Using a Vascularized Tibial Periosteum Transplant: A Case Report. Revista De La Asociación Argentina De Ortopedia Y Traumatología, 90(1), 90-96. https://doi.org/10.15417/issn.1852-7434.2025.90.1.1720
Issue
Section
Case Presentations
Copyright (c) 2025 Revista de la Asociación Argentina de Ortopedia y Traumatología
Manuscript acceptance by the Journal implies the simultaneous non-submission to any other journal or publishing house. The RAAOT is under the Licencia Creative Commnos Atribución-NoComercial-Compartir Obras Derivadas Igual 4.0 Internacional (CC-BY-NC.SA 4.0) (http://creativecommons.org/licences/by-nc-sa/4.0/deed.es). Articles can be shared, copied, distributed, modified, altered, transformed into a derivative work, executed and publicly communicated, provided a) the authors and the original publication (Journal, Publisher and URL) are mentioned, b) they are not used for commercial purposes, c) the same terms of the license are maintained.
In the event that the manuscript is approved for its next publication, the authors retain the copyright and will assign to the journal the rights of publication, edition, reproduction, distribution, exhibition and communication at a national and international level in the different databases. data, repositories and portals.
It is hereby stated that the mentioned manuscript has not been published and that it is not being printed in any other national or foreign journal.
The authors hereby accept the necessary modifications, suggested by the reviewers, in order to adapt the manuscript to the style and publication rules of this Journal.
References
1. Witoonchart K, Uerpairojkit C, Leechavengvongs S, Thuvasethakul P. Congenital pseudarthrosis of the forearm
treated by free vascularized fibular graft: A report of three cases and a review of the literature. J Hand Surg
1999;24:1045-55. https://doi.org/10.1053/jhsu.1999.1045
2. Bauer AS, Singh AK, Amanatullah D, Lerman J, James MA. Free vascularized fibular transfer with langenskiöld
procedure for the treatment of congenital pseudarthrosis of the forearm. Tech Hand Up Extrem Surg 2013;17(3):144-50. https://doi.org/10.1097/BTH.0b013e318295238b
3. Siebelt M, de Vos-Jakobs S, Koenrades N, van Nieuwenhoven CAV, Oostenbrink R, Bramer WM, et al. Congenital
forearm pseudarthrosis, a systematic review for a treatment algorithm on a rare condition. J Pediatr Orthop
2020;40(5):e367-e374. https://doi.org/10.1097/BPO.0000000000001417
4. Allieu Y, Gomis R, Yoshimura M, Dimeglio A, Bonnel F. Congenital pseudarthrosis of the forearm-two cases treated by free vascularized fibular graft. J Hand Surg Am 1981;6(5):475-81. https://doi.org/10.1016/s0363-5023(81)80108-6
5. Beris AE, Lykissas MG, Kostas-Agnantis I, Vasilakakos T, Vekris MD, Korompilias AV. Congenital pseudarthrosis
of the radius treated with gradual distraction and free vascularized fibular graft: case report. J Hand Surg Am
2010;35(3):406-11. https://doi.org/1010.1016/j.jhsa.2009.11.022
6. Soldado F, Barrera-Ochoa S, Fontecha CG, Haddad S, Barastegui D, Barber I, et al. Vascularized periosteal graft
from the first metatarsal bone: A new technique to prevent collapse of osteonecrosis of the talus in children. A case report. Microsurgery 2013;33:56-9. https://doi.org/10.1002/micr.22045
7. Diaz-Gallardo P, Knörr J, Vega-Encina I, Corona PS, Barrera-Ochoa S, Rodriguez-Baeza A, et al. Free vascularized
tibial periosteal graft with monitoring skin island for limb reconstruction: Anatomical study and case report.
Microsurgery 2017;37(3):248-51. https://doi.org/10.1002/micr.30011
8. Soldado F, Garcia Fontecha C, Haddad S, Hernandez-Fernandez A, Corona P, Guerra-Farfan E. Treatment of
congenital pseudarthrosis of the tibia with vascularized fibular periosteal transplant. Microsurgery 2012;32(5):397-400. https://doi.org/10.1002/micr.21985
9. Soldado F, Barrera-Ochoa S, Bergua-Domingo JM, Domenech P, Corona PS, Knorr J. Bone nonunion management in children with a vascularized tibial periosteal graft. Microsurgery 2020;40(7):760-5.
https://doi.org/10.1002/micr.30655
10. Patel SP, Anthony SG, Zurakowski D, Didolkar MM, Kim PS, Wu JS, et al. Radiographic scoring system to evaluate union of distal radius fractures. J Hand Surg Am 2014;39(8):1471-9. https://doi.org/10.1016/j.jhsa.2014.05.022
11. Sellers DS, Sowa DT, Russell Moore J, Weiland AJ. Congenital pseudarthrosis of the forearm. J Hand Surg 1988;13:89-93. https://doi.org/10.1016/0363-5023(88)90207-9
12. Escobedo-Troncoso VM, Cantú-Morales D. [Formation of a single bone in the forearm in infected pseudoarthrosis of the proximal ulna]. Acta Ortop Mex 2015;29(2):114-7. PMID: 27024890
13. Allieu Y, Meyer zu Reckendorf G, Chammas M, Gomis R. Congenital pseudarthrosis of both forearm bones: longterm results of two cases managed by free vascularized fibular graft. J Hand Surg Am 1999;24(3):604-8.
https://doi.org/10.1053/jhsu.1999.0604
14. Mathoulin C, Gilbert A, Azze RG. Congenital pseudarthrosis of the forearm: Treatment of six cases with
vascularized fibular graft and a review of the literature. Microsurgery 1993;14:252-9. https://doi.org/10.1002/micr.1920140408
15. Barrera-Ochoa S, Martin-Dominguez LA, Campillo-Recio D, Alabau-Rodriguez S, Mir-Bullo X, Soldado F. Are
vascularized periosteal flaps useful for the treatment of difficult scaphoid nonunion in adults? A prospective cohort study of 32 patients. J Hand Surg Am 2020;45(10):924-36. https://doi.org/10.1016/j.jhsa.2020.06.013
16. Barrera-Ochoa S, Mendez-Sanchez G, Mir-Bullo X, Knörr J, Bertelli JA, Soldado F. Vascularized thumb metacarpal periosteal flap for scaphoid nonunion in adolescents: A prospective cohort study of 12 patients. J Hand Surg Am 2019;44(6):521.e1-521.e11. https://doi.org/10.1016/j.jhsa.2018.08.019
17. Barrera-Ochoa SS, Sergi Barrera-Ochoa S, Soldado F, Rodriguez-Baeza A, Diaz-Gallardo P, Hodgson F, et al.
Vascularized humeral periosteal flap to treat lateral humeral condyle nonunion: An anatomical study and report of two successfully-treated pediatric cases. Microsurgery 2019;39:156-9. https://doi.org/10.1002/micr.30261
18. Barrera-Ochoa S, Velez R, Rodriguez-Baeza A, De Bergua-Domingo JM, Knörr J, Soldado F. Vascularized ulnar
periosteal pedicled flap for forearm reconstruction: Anatomical study and a case report. Microsurgery 2018;38:530-5. https://doi.org/10.1002/micr.30208
19. Soldado F, Knörr J, Haddad S, Corona PS, Barrera-Ochoa S, Collado D, et al. Vascularized tibial periosteal graft in complex cases of bone nonunion in children. Microsurgery 2015;35(3):239-43. https://doi.org/10.1002/micr.22342
20. Iamaguchi RB, Fucs PMM, da Costa AC, Chakkour I. Vascularised fibular graft for the treatment of congenital
pseudarthrosis of the tibia: long-term complications in the donor leg. Int Orthop 2011;35:1065-70.
https://doi.org/10.1007/s00264-010-1103-8
treated by free vascularized fibular graft: A report of three cases and a review of the literature. J Hand Surg
1999;24:1045-55. https://doi.org/10.1053/jhsu.1999.1045
2. Bauer AS, Singh AK, Amanatullah D, Lerman J, James MA. Free vascularized fibular transfer with langenskiöld
procedure for the treatment of congenital pseudarthrosis of the forearm. Tech Hand Up Extrem Surg 2013;17(3):144-50. https://doi.org/10.1097/BTH.0b013e318295238b
3. Siebelt M, de Vos-Jakobs S, Koenrades N, van Nieuwenhoven CAV, Oostenbrink R, Bramer WM, et al. Congenital
forearm pseudarthrosis, a systematic review for a treatment algorithm on a rare condition. J Pediatr Orthop
2020;40(5):e367-e374. https://doi.org/10.1097/BPO.0000000000001417
4. Allieu Y, Gomis R, Yoshimura M, Dimeglio A, Bonnel F. Congenital pseudarthrosis of the forearm-two cases treated by free vascularized fibular graft. J Hand Surg Am 1981;6(5):475-81. https://doi.org/10.1016/s0363-5023(81)80108-6
5. Beris AE, Lykissas MG, Kostas-Agnantis I, Vasilakakos T, Vekris MD, Korompilias AV. Congenital pseudarthrosis
of the radius treated with gradual distraction and free vascularized fibular graft: case report. J Hand Surg Am
2010;35(3):406-11. https://doi.org/1010.1016/j.jhsa.2009.11.022
6. Soldado F, Barrera-Ochoa S, Fontecha CG, Haddad S, Barastegui D, Barber I, et al. Vascularized periosteal graft
from the first metatarsal bone: A new technique to prevent collapse of osteonecrosis of the talus in children. A case report. Microsurgery 2013;33:56-9. https://doi.org/10.1002/micr.22045
7. Diaz-Gallardo P, Knörr J, Vega-Encina I, Corona PS, Barrera-Ochoa S, Rodriguez-Baeza A, et al. Free vascularized
tibial periosteal graft with monitoring skin island for limb reconstruction: Anatomical study and case report.
Microsurgery 2017;37(3):248-51. https://doi.org/10.1002/micr.30011
8. Soldado F, Garcia Fontecha C, Haddad S, Hernandez-Fernandez A, Corona P, Guerra-Farfan E. Treatment of
congenital pseudarthrosis of the tibia with vascularized fibular periosteal transplant. Microsurgery 2012;32(5):397-400. https://doi.org/10.1002/micr.21985
9. Soldado F, Barrera-Ochoa S, Bergua-Domingo JM, Domenech P, Corona PS, Knorr J. Bone nonunion management in children with a vascularized tibial periosteal graft. Microsurgery 2020;40(7):760-5.
https://doi.org/10.1002/micr.30655
10. Patel SP, Anthony SG, Zurakowski D, Didolkar MM, Kim PS, Wu JS, et al. Radiographic scoring system to evaluate union of distal radius fractures. J Hand Surg Am 2014;39(8):1471-9. https://doi.org/10.1016/j.jhsa.2014.05.022
11. Sellers DS, Sowa DT, Russell Moore J, Weiland AJ. Congenital pseudarthrosis of the forearm. J Hand Surg 1988;13:89-93. https://doi.org/10.1016/0363-5023(88)90207-9
12. Escobedo-Troncoso VM, Cantú-Morales D. [Formation of a single bone in the forearm in infected pseudoarthrosis of the proximal ulna]. Acta Ortop Mex 2015;29(2):114-7. PMID: 27024890
13. Allieu Y, Meyer zu Reckendorf G, Chammas M, Gomis R. Congenital pseudarthrosis of both forearm bones: longterm results of two cases managed by free vascularized fibular graft. J Hand Surg Am 1999;24(3):604-8.
https://doi.org/10.1053/jhsu.1999.0604
14. Mathoulin C, Gilbert A, Azze RG. Congenital pseudarthrosis of the forearm: Treatment of six cases with
vascularized fibular graft and a review of the literature. Microsurgery 1993;14:252-9. https://doi.org/10.1002/micr.1920140408
15. Barrera-Ochoa S, Martin-Dominguez LA, Campillo-Recio D, Alabau-Rodriguez S, Mir-Bullo X, Soldado F. Are
vascularized periosteal flaps useful for the treatment of difficult scaphoid nonunion in adults? A prospective cohort study of 32 patients. J Hand Surg Am 2020;45(10):924-36. https://doi.org/10.1016/j.jhsa.2020.06.013
16. Barrera-Ochoa S, Mendez-Sanchez G, Mir-Bullo X, Knörr J, Bertelli JA, Soldado F. Vascularized thumb metacarpal periosteal flap for scaphoid nonunion in adolescents: A prospective cohort study of 12 patients. J Hand Surg Am 2019;44(6):521.e1-521.e11. https://doi.org/10.1016/j.jhsa.2018.08.019
17. Barrera-Ochoa SS, Sergi Barrera-Ochoa S, Soldado F, Rodriguez-Baeza A, Diaz-Gallardo P, Hodgson F, et al.
Vascularized humeral periosteal flap to treat lateral humeral condyle nonunion: An anatomical study and report of two successfully-treated pediatric cases. Microsurgery 2019;39:156-9. https://doi.org/10.1002/micr.30261
18. Barrera-Ochoa S, Velez R, Rodriguez-Baeza A, De Bergua-Domingo JM, Knörr J, Soldado F. Vascularized ulnar
periosteal pedicled flap for forearm reconstruction: Anatomical study and a case report. Microsurgery 2018;38:530-5. https://doi.org/10.1002/micr.30208
19. Soldado F, Knörr J, Haddad S, Corona PS, Barrera-Ochoa S, Collado D, et al. Vascularized tibial periosteal graft in complex cases of bone nonunion in children. Microsurgery 2015;35(3):239-43. https://doi.org/10.1002/micr.22342
20. Iamaguchi RB, Fucs PMM, da Costa AC, Chakkour I. Vascularised fibular graft for the treatment of congenital
pseudarthrosis of the tibia: long-term complications in the donor leg. Int Orthop 2011;35:1065-70.
https://doi.org/10.1007/s00264-010-1103-8