Juvenile Metacarpal Bone Missing: Reconstruction by Free Vascularized Iliac Bone Graft Including Its Cartilage for Bone Growth Consideration

Abstract

Background: Severe crush injury to hand may lead metacarpal bones even carpal bones loss and reconstruction for this injury especially in growing children was a great challenge on shape, function and growth concerns. Vascularized iliac bone graft was mostly used in femoral head necrosis, mandibular defect, tibial osteomyelitis, scaphoid or lunate carpal bone reconstruction, but no report for metacarpal bones missing reconstruction. We here report our experience in 2 cases with a long-standing follow-up. Method: Two cases are in this study. One is a 7 year-old girl suffering from compression and contact burn injury over right hand with 2nd to 5th metacarpal bones loss. The other is a boy with same age suffering from right hand crushing injury with 4th and 5th metacarpal and almost all carpal bones loss. Both received free vascularized iliac osteocutaneous flap for reconstruction. Both have at least 5 years follow-up. Bone length was measured regularly in the clinics. Result: Both patients got acceptable function and appearance. The girl patient had 1.07mm in length and 0.94mm in width and the boy patient had 1.69mm in length and 1.40mm in width of yearly iliac bone growth ini the traumatized hand. The transferred iliac bone graft is growing but slower than the normal hand growing. Conclusion: Although free vascularized iliac bone graft might be a suitable choice of reconstruction for child patient with missing metacarpal and/or carpal bones, further improvement including more iliac crest cartilage and more iliac bone harvest than the measurement from the non-traumatized hand should be considered in the next similar cases.