The authors present a method of successful reconstruction of a massive bone and soft-tissue defect of the forearm. A 10 year-old child suffered a crush injury of the forearm, resulting in loss of the entire distal ulna beyond the proximal diaphysis, as well as the central 50% of the radius. Associated soft-tissue injuries included division of the ulnar artery and nerve. Distal circulation remained intact through the radial artery. After initial stabilization and debridements, the forearm was reconstructed one month after injury with a vascularized fibula/peroneus/soleus flap and sural nerve grafts. The fibula graft was fixed to the proximal and distal radius with screws, and the proximal radioulnar joint was fused. At two-year follow-up, the construct was stable with a fixed 30-degree supination position of the forearm and an 85-degree total arc of motion at the elbow. The authors rated the results as “good,” using the Peterson scoring system.
This case illustrates a creative solution to a very challenging reconstructive problem. The authors were able to salvage a functional forearm in an injury with loss of over 50% of both bones and a large soft-tissue defect. Bony defects over approximately 6cm typically require vascularized methods. The availability of significant bony length, adjacent muscle, fascia and skin make the free fibula an important tool in limb salvage reconstruction. In patients with intact ulnohumeral and radiocarpal joints, this reconstruction can lead to a functional upper limb, avoiding amputation and prosthetics.