title: Surgical technique: Tibia cortical strut autograft interposition arthrodesis after distal radius resection.
abstract: BACKGROUND
  Distal radius reconstruction after en bloc tumor resection remains a surgical challenge. Although several surgical techniques, either reconstructing the wrist or achieving a stable arthrodesis, have been described, it is unclear to what degree these restore function.
  
  
  METHODS
  We describe an updated technique making use of a tibia cortical strut autograft (TCSA) to perform a functional arthrodesis from the remaining radius to the first carpal row. This, in theory, could lead to less donor site morbidity while resulting in a stable but functional and pain-free arthrodesis of the wrist.
  
  
  METHODS
  Between 1987 and 2010 we reconstructed the wrists of 17 patients using a TCSA arthrodesis (six primary and three revisions), seven with an osteoarticular allograft, three using an ulnar translocation, and one with a fibula autograft. Median age at diagnosis was 24 years (range, 9-58 years) and minimum followup was 2.7 years (median, 13.8 years; range, 2.7-24.5 years). Patients were evaluated using radiographs and clinical examination. We used Musculoskeletal Tumor Society (MSTS), Disabilities of the Arm, Shoulder, and Hand (DASH), and SF-36 questionnaires to assess function and quality of life.
  
  
  RESULTS
  All TCSA reconstructions fused; one patient had a second surgery to expedite union with the carpal row. After osteoarticular allograft, five patients were revised (three to a TCSA) for nonunion, fracture, or joint collapse. ROM and grip strength were comparable in both AO and TCSA, all above 60% of the contralateral side. Median MSTS and DASH scores were 73% and 6, respectively, and did not differ between the groups. The SF-36 scores showed less pain after TCSA; otherwise, all patients presented with comparable function.
  
  
  CONCLUSIONS
  TCSA wrist arthrodesis resulted in a functional and painless wrist reconstruction with a relatively low complication and donor site morbidity rate and comparable functional results as other techniques.
  
  
  METHODS
  Level III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
authors.affiliation: Department of Orthopedic Surgery, Leiden University Medical Center, Postzone J11-R-70, PO Box 9600, 2300 RC Leiden, The Netherlands. m.a.j.van_de_sande@lumc.nl
authors.forename: Michiel A J
authors.initials: MA
authors.lastname: van de Sande
authors.forename: Niels H W
authors.initials: NH
authors.lastname: van Geldorp
authors.forename: P D Sander
authors.initials: PD
authors.lastname: Dijkstra
authors.forename: Antonie H M
authors.initials: AH
authors.lastname: Taminiau
mesh_terms: D000293:Adolescent; D000328:Adult; D001174:Arthrodesis / Q000009:adverse effects; D001696:Biomechanical Phenomena; D001859:Bone Neoplasms / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D002648:Child; D004185:Disability Evaluation; D005260:Female; D005360:Fibula / Q000637:transplantation; D006801:Humans; D008297:Male; D008875:Middle Aged; D010027:Osteotomy / Q000009:adverse effects; D010149:Postoperative Pain / Q000209:etiology; D010808:Physical Examination; D011237:Predictive Value of Tests; D011788:Quality of Life; D011859:Radiography; D011884:Radius / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D019651:Plastic Surgery Procedures / Q000009:adverse effects / Q000379:methods*; D020127:Recovery of Function; D012189:Retrospective Studies; D012983:Soft Tissue Neoplasms / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D011795:Surveys and Questionnaires; D013977:Tibia / Q000637:transplantation*; D013997:Time Factors; D014182:Transplantation, Autologous; D016896:Treatment Outcome; D014457:Ulna / Q000601:surgery; D014955:Wrist Joint / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D055815:Young Adult