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. 2023 May;143(5):2437-2446.
doi: 10.1007/s00402-022-04460-y. Epub 2022 May 9.

Autologous replacement of the head of the radius-proximal fibula versus second metatarsal base: an anatomic feasibility study

Sebastian Farr  1 , Julian Augustin  2 , Sebastian Röhrich  3 , Martina Felbermeier  3 , Lena Hirtler  4
Affiliations

Autologous replacement of the head of the radius-proximal fibula versus second metatarsal base: an anatomic feasibility study

Sebastian Farr et al. Arch Orthop Trauma Surg. 2023 May.

Abstract

Introduction: This study investigated the anatomic feasibility of a new surgical therapy option for radial head arthrosis using an autologous vascularized bone graft of the second metatarsal and proximal fibula to recreate the proximal radiohumeral joint.

Materials and methods: Upper and lower extremities of eleven body donors were evaluated using CT prior to anatomic dissection. Several distinct anatomic parameters were measured on the ipsi- and contralateral radial and fibular head and the second metatarsal base: bone diameter, articular surface diameter, head height, metaphyseal (neck) diameter, articular surface radius, total articular surface area, and angulation of the articular surfaces (facet). Each dissection phase was photographed in a standardized fashion and all measurements were repeated by direct caliper-measurements.

Results: When comparing the proximal radius and fibula to search for anatomic similarities, similar values were found in the maximum articular surface diameter and minimum and maximum measures of the neck diameter. Comparing the proximal radius and the second metatarsal, statistically similar values were found in the maximum neck diameter performing direct measurements and CT evaluation, the maximum head diameter in CT evaluation and the articular facet angulation.

Conclusions: Neither the proximal fibula nor the base of the second metatarsal are ideal bone grafts for replacement of the head of the radius. The base of the second metatarsal might be a bit more suitable as a potential donor since the angulation of the proximal articular facet is similar to that of the radius.

Level of evidence: Level IV, anatomic study.

Keywords: Elbow prosthesis; Fibular autograft; Osteoarthritis; Radial head; Radial head dislocation; Radial head fracture; Second metatarsal.

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Conflict of interest statement

All authors declare no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Fig. 1
Fig. 1
The anatomic radial head measurements are shown: bone diameter (A, B), articular surface diameter (C), angulation of the articular surface (D), head height (E), neck diameter (F), articular surface area (G), and articular surface radius (H)
Fig. 2
Fig. 2
The anatomic fibular head measurements are shown: bone diameter (A), articular surface diameter (B), head height (C), neck diameter (D), articular surface area (E), angulation of the articular surface (F), and articular surface radius (G)
Fig. 3
Fig. 3
The anatomic second metatarsal base measurements are shown: bone diameter (A), articular surface diameter (B), articular surface area (C), head height (D), articular surface radius (E), and angulation of the articular surface (F)
See this image and copyright information in PMC

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