Use of an Iliac Crest Growth Plate for the Development of a Neo-articulation for Congenital Transverse Deficiencies at the Wrist

作者：Deroussen F; Gouron R^*; Juvet Segarra M; Maes Clavier C; Plancq M C; Collet L M

来源：Journal of Hand Surgery-American Volume, 2012, 37A(10): 2061-2067.

DOI：10.1016/j.jhsa.2012.06.023

• Children
• congenital deficiency of hand
• growth plate graft
• neo-articulation

Purpose Terminal congenital transverse deficiencies of the wrist and hand are rare malformations. They are usually treated with prosthetic devices. We describe here a surgical technique to create a neo-articulation that could provide mobility distal to the forearm and help children with terminal transverse deficiencies use orthotic devices. %26lt;br%26gt;Methods This procedure involved an autologous, nonvascularized graft from the immature iliac crest. The graft was placed with its cartilaginous side facing the radial and ulnar articular surfaces. We studied the clinical, radiological, and functional outcomes of this technique in 2 pediatric cases 5 and 14 years after this procedure. %26lt;br%26gt;Results The x-rays showed a mobile graft distally in the forearm. Magnetic resonance imaging showed a space between the graft and the radius and an intermediate signal on either side of the space highly suggestive of articular cartilage. These various elements were organized into a neo-articulation between the forearm and the graft. The functional ability at follow-up was greater compared with the absence of a graft. %26lt;br%26gt;Conclusions The results of basic research work on cartilage and chondrocytes may help explain the presence of persistent cartilaginous tissue on the articulated part of the graft. The good functional outcome provided by our surgical procedure may translate into reduced need for prosthesis acceptance. Our surgical procedure does not restore limb length, but does add a new functional ability. (J Hand Surg 2012;37A:2061-2067.

• 出版日期2012-10