Reconstruction of the Distal Radius Articular Facet by a Free Vascularized Osteochondral Autograft: Anatomic Study and Report of Two Cases

Large chondral defects after fractures present a phenomenal reconstructive challenge. The purpose of this study was to introduce the concept of the vascularized osteochondral graft, to present anatomic findings in the cadaver of vascularized osteochondral autografts appropriate for reconstructing the distal radius articular facet, and to present two patients in whom this technique was used.

The bases of the second and third metatarsals were studied in the feet of 20 cadavers. The size and shape of the cartilage were measured. Additionally, vessel distribution was recorded and the diameter of the vascular foramina were measured with Juch's method.

The base of the third metatarsal is pear–shaped and wider dorsally (12.6 mm) than plantarly (7.9 mm); it is 19.2 mm maximum length on its main axis. Its cartilaginous surface is minimally concave or flat, and it is slightly slanted proximal–dorsal to distal–plantar and proximal–peroneal to distal–tibial. Nutrient foramina were found in every case in the dorsum and both sides of the proximal shaft. At least one nutrient vessel could be tracked back to the dorsalis pedis in every dissected specimen.

A 33-year–old male had his scaphoid fossa reconstructed by a 19-x 9-mm vascularized osteochondral graft taken from the third metatarsal. The dorsalis pedis artery and venae comitantes were anastomosed to the radial artery and local veins. Profuse bleeding from the transferred bone and skin monitor was noted.

Eight months later, he wished to have an improvement in range of motion (AROM: extension 20°, flexion 45°). Arthroscopic arthrolysis was performed. Complete integrity of the transferred cartilage with normal adherence to the subchondral bone was appreciated during the arthroscopic procedure.

At a 1-year follow–up visit, pain had improved from 9 to 1.5 on a VAS (Visual Analogue Scale: 0 = no pain.....10 = maximum pain). AROM: extension 42°, flexion 50°. Grip strength was 78% of the contralateral side. Complaints from the donor site were minimal.

A 56-year–old male had his lunate facet–sigmoid facet destroyed after a fracture. When referred 3 months later, he had pain, a minimal range of motion, and 0° of supination. The lunate facet–sigmoid notch complex was reconstructed with the described technique with similar results at 6 months (supination improved to 80°). Again, no complaints at the donor site were reported.

The procedure is indicated for irreparable chondral defects of the radius and it is a reasonable alternative to partial or total arthrodeses. Several anatomic donor sites were investigated, but the third metatarsal base was judged ideal.