Use of a vascularized osteochondral graft from the base of the third metastarsal to address intraarticular malunions of the distal radius

Purpose Post-traumatic joint defect reconstruction constitutes a significant challenge for any surgeon. We hereby present our experience of using vascularized osteochondral grafts from the base of the third metatarsal to reconstruct large defects on the distal articular surface of the radius. Case reports Surgery was performed on three adults with articular defects in their distal radius and massive cartilage loss who were not eligible for correction through articular osteotomy. In 2 cases, the semilunar notch, and sigmoid cavity, were reconstructed; the scaphoid fossa was reconstructed in the third. Time from fracture to surgery went from 3 to 18 months. In all cases, a transplant was made of a pediculated graft of the base of the third metatarsal pedicled on the dorsal foot veins and arteries with a skin island, revascularized through termino lateral anastomoses to the radial artery and to the veins of the anatomic snuffbox. Results No vascular complications were detected. The postoperative flexion-extension range improved by a mean of 65°, strength by 52 kg and the pain score, measured on a visual analog scale, 9 to 1.16 points. As regards the donor site, neither metatarsalgia nor gait difficulties were observed. One patient reported discomfort on the dorsum of the foot when wearing tight footwear, resulting from a likely neuroma of the deep peroneal nerve, which improved after 12 months. Conclusions Transplanting a vascularized osteochondral graft from the base of the third metatarsal is a useful therapeutic alternative to treat massive defects of the distal articulation of the radial bone. Sequelae at the donor site have been minimal.