Surgical treatment of infected bones with vascularised bone grafts is well established as an efficient strategy since several years. Nevertheless orthopaedic and trauma surgeons seem to apply vascularised bone grafts as the last treatment option only. Two strategies exist for treatment of chronically infected bones with vascularised bone grafts. First: Complete resection of the infected, often non-united part of the bones and reconstruction with large vascularised bone grafts, mostly fibular grafts. Second: Augmentation of the kept and intact parts of the bones with vascularised bone grafts. Two small series of patients are presented to illustrate both techniques and to show the results and outcome. Resection of big parts of the tibia and reconstruction with mostly ipsilateral fibular grafts – single barrel in children and double barrel in adults – led to uneventful healing in all cases. Augmentation of radius, femur and calcaneus with vascularised grafts from the iliac crest or the scapula was followed by primary healing, too. All patients were disburdened from infection up to now and regained full extremity function. The presented vascularized bone grafts did not only salvage the extremities but also could maintain their functionality. The procedure is demanding, but reliable and safe at a low rate of complications. Thus vascularised bone grafts should not only be used as ultimative salvage procedures, but as early as possible whenever standard treatments for osteomyelitis fail.
Classically Radioulnar Synostosis is corrected by rotation-osteotomy. Kanaya first presented a technique for “dynamic” treatment of the deformity. In our institution two cases were treated with a procedure according to Kanayas technique. A four and half year old girl suffered from bilateral radioulnar synostosis, thus presenting the classic indication for surgical correction at least of one side – in our right handed case the left side. A forteen year old boy suffered from radioulnar synostosis of his right upper limb. An increasing luxation of the radial head, causing pain and deformity and decreasing function of the elbow necessitated a surgical intervention. The procedure used was performed identically in both cases: Division of the synostosis and shortening-wedge osteotomy of the proximal radius as described by Kanaya. A deepithelialized fasciocutaneous flap was raised from the dorsum of the proximal forearm and rotated in a position between the separated bones. A cast was applied for six weeks. Wound healing and consolidation of bones was achieved without problems in both cases. At a 12 months follow up the space between radius and ulna remained open, with no evidence of reoccurence of the deformity. Opening of the synostosis did not affect ellbow flexion and extension and produced an active ROM of about 30 to 40 degrees in pronation; both patients reached neutral position but did neither achieve passive nor active supination. In our hands Kanayas technique was sufficient for bone separation and produced some active movement, but could not produce active supination. Investigation of the wrists did not reveal deformities of these joints. At the moment the reason for the lack of real supination is not clear. Actually this problem has to be solved to improve the technique to a real dynamic treatment of radioulnar synostosis.
