Lambeau osseux interosseux postérieur pour l’avant-bras pédiatrique

Abstract

Posterior interosseous bone flap (PIBF) is a reliable vascularised bone graft in adults for treatment of forearm and elbow difficult nonunions. In our best knowledge there is no published experiments on this technique in children. We reviewed our patients and found 6 patients with PIBF for treatment of forearm nonunions and distal radius physeal arrest. From May 2015 to December 2017, six patients from 2 to 8 years old underwent PIBF from distal ulna. The indication of this treatment were, radius congenital pseudoarthrosis two patients, non-union due to chronic osteomyelitis one patient, radius traumatic non-union one patient, distal radius physeal arrest due to enchondroma two patients. In non-union cases, one half of diameter from 2–3 cm of distal ulnar metaphysis harvested on the base of posterior interosseous vessels and transferred to non-union site of the radius. For transfer of the physis whole distal 2 cm of ulna, including physis harvested on the base of these vessels and transferred to the distal radius after resecting damaged physis. All nonunions healed in 3 to 4.5 months. Ulnar fracture and radial head gradual dislocation occurred in one patent with congenital pseudoarthrosis. Non of physeal transfers ended to normal growth due to bony bridge. Non-union is rare in paediatric forearm but if it stablished it is difficult to be treated. Congenital pseudoarthrosis and chronic osteomyelitis are the examples of underlying disease, which make the treatment so difficult. Free fibular transfer is the treatment of choice, but it is a demanding technique and the donor site complications is frequent. Pedicle bone graft is a simple alternative for this procedure. In our patients PIBF worked with complete union in an acceptable time without sever complications. Distal radius physeal arrest especially in young children is a disabling condition. Lengthening over the time is a time consuming procedure. Free phseal transfer is an attractive idea. Unfortunately with PIBF technique transferred physis didn’t work, because of bony bridge around the physis. PIBF works in the paediatric difficult forearm nonunions. But because of smaller size of the ulna, more meticulous techniques should be done. Physeal transfer of distal ulna to radius is not successful with this technique and needs further investigations.