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Free Vascularized Fibular Transfer With Langenskiöld Procedure for the Treatment of Congenital Pseudarthrosis of the Forearm

Bauer, Andrea S. MD; Singh, Avreeta K. BS; Amanatullah, Derek MD; Lerman, Joel MD; James, Michelle A. MD

Techniques in Hand & Upper Extremity Surgery: September 2013 - Volume 17 - Issue 3 - p 144–150
doi: 10.1097/BTH.0b013e318295238b

Congenital pseudarthrosis of the radius or ulna is a rare entity. It is associated with neurofibromatosis, but occurs much less commonly than congenital pseudarthrosis of the tibia. Pseudarthrosis of the forearm can lead to pain, deformity, and limited forearm rotation. Nonsurgical management leads to poor results, as do surgical treatments such as open reduction internal fixation and conventional bone grafting. The transfer of a free vascularized fibula to the forearm pseudarthrosis has been more successful, and it is our preferred method of treatment for children with this condition. Because the transfer is often performed in young children, there is the potential for valgus deformity at the ankle after the fibula is removed. We describe here our technique for the transfer, including the technique for distal tibiofibular fusion (Langenskiöld procedure) after removal of the fibular graft. In addition, we present the results of 5 patients who have undergone this combination of procedures for pseudarthrosis of the forearm at our institution.

Shriners Hospital for Children Northern California, Sacramento, CA

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 Andrea S. Bauer, MD, Shriners Hospital for Children Northern California, 2425 Stockton Blvd, Sacramento, CA 95817. E-mail:

© 2013 by Lippincott Williams & Wilkins