TechniquesDouble Vascularized Fibula Proximal Growth Plate Transplantation: Novel Technique for the Radial Longitudinal Deficiency (RLD) Grade IV ReconstructionOzols, Dzintars MD, PhD*,†,‡; Butnere, Marisa M. MD*,†; Kalnina, Linda MD*; Mokanu, Arturs MD*; Ozola, Santa MD*; Mikitins, Aleksandrs MD†; Petersons, Aigars MD, PhD*,† Author Information *Department of Pediatric Surgery, Riga Stradins University †Department of Paediatric Surgery, Children Clinical University Hospital ‡Department of Hand and Plastic Surgery, Microsurgery Centre of Latvia, Riga East University Hospital, Riga, Latvia Approval nr.6-3/2/47 has been received before study from Riga Stradins University ethical committee. Conflicts of Interest and Source of Funding: The authors report no conflicts of interest and no source of funding. Address correspondence and reprint requests to Dzintars Ozols, MD, PhD, Vienibas Gatve 45, Riga LV-1004, Latvia. E-mail: [email protected]. Techniques in Hand & Upper Extremity Surgery 26(2):p 98-102, June 2022. | DOI: 10.1097/BTH.0000000000000366 Buy Metrics Abstract Radial absence or severe hypoplasia in radial longitudinal deficiency (RLD) is most commonly treated through stabilization of the carpus on the ulna (centralization or radialization) with or without preliminary distraction. Alternative methods include bone transfer to replace the absent or deficient radius using the proximal fibula, vascularized or nonvascularized, and more recently the transfer of a vascularized second metatarsophalangeal joint. There is paucity of articles suggesting vascularized fibula growth plate transfer for RLD grade III where proximal part of radius can be found and none about double fibular growth plate transplantation. We developed new technique a bilateral growth plate transplantation for the pediatric patient with unilateral RLD stage IV (Bayne and Klug). Totally 2 patients were operated using new technique. No vascular problems occurred and no peroneal nerve damage were observed at the follow-ups. Annual growth was determined on x-rays at the 1 and 2-year follow-ups measuring 0.75 to 0.9 cm with open growth plates. The x-rays also show no changes that can harm the long-term growth potential in the forearm, demonstrating this technique’s capacity to achieve better results for forearm length and functionality in comparison to the Vilkki procedure or radialization operation and there is no need to sacrifice second toe. Thumb reconstruction can be done at age 3 or 4 years using pollicization or toe-to hand transplantation techniques. The patients and parents are satisfied with functional and esthetic outcomes. We believe the double fibular growth plate transplantation is a promising method to use to reconstruct unilateral RLD grade IV. Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.