PMC6968543_01
CT images showing an irregular articular surface due to poor reduction in the initial surgery.
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Radiographs showed an irregular articular surface of the distal radius due to poor reduction in the initial surgery (Figure 1).
(A) Immediately postoperative radiograph of the radiolunate arthrodesis with the iliac crest. (B) Radiograph at 6 months after the first radiolunate arthrodesis showing nonunion.
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Removal of the plate and radiolunate arthrodesis with a free iliac bone graft was performed in our department (Figure 2(A)). However, the pain was still present at 6 months postoperatively, and radiography showed nonunion and loosening around the screws (Figure 2(B)).
(A) Intraoperative photograph of the vascularized bone graft at the time of harvesting. (B) Immediately postoperative photograph of the wrist with the external fixation device. (C) At 3 months after the last surgery, a radiograph confirmed bony union.
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The patient was then treated with a vascularized bone graft from a medial femoral condyle bone flap (Figure 3).
Diagrams of the surgical procedure. The bone graft was placed between the lunate and radius with a slight distraction of the lunate. End-to-end anastomosis was performed into the dorsal branch of the radial artery.
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The bone graft was tailored to fit the radiocarpal joint and was placed between the lunate and distal radius with a slight distraction of the lunate, decompressing the scaphoid (Figure 4).