Capitellum Reconstruction Using Metatarsal Head Vascularized Transfer

Abstract

Treatment for the sequelae of capitellum fractures is not commonly described in the literature. We present a unique case of a capitellum reconstruction with a vascularized ossseus graft from the second metatarsal bone. A woman of 53 years old fell down and presented a capitellum fracture that was fixed with two cannulated screws, after 6 months the radiograph showed signs of necrosis of the capitellum, the patient was disabled and a surgery was offered. We reconstructed her capitellum by means of a vascularized osteochondral flap from the second metatarsal bone, and end-to-side anastomosis to the radial artery was performed and two cannulated screws were used to fix the graft to the humeral lateral column. After almost two years of follow up the patient is free of pain and is able to perform the activity of the daily live. The vascularized transfer from the foot is a valid technique for the reconstruction of the capitellum in non-synthesizable fractures mainly when the lateral column of the humerus is affected. The complications in the donor site are minimal.