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Joint reconstruction. Transfer of epiphysis and growth plate of the vascularized fibula

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One of the most complicated situations is the reconstruction of large joints (hip, shoulder, etc.) in very early ages. They are more often due to tumors of the epiphysis (Fig. 11A).

In this age group prosthesis are not recommended, since they would require many surgeries throughout life. Neither allograft tissue bank, because they have no ability to grow and would further develop early osteoarthritis.

The transfer of a vascularized fibular epiphysis, although a very complex procedure, allows us to reconstruct the joint. Over time, the ability of remodeling of the head and length growth resulting from the presence of the physis, allows to obtain a durable anatomic joint (Fig. 11B-C).


Figure 11A. 4 year old boy with a malignant tumor in the proximal femoral epiphysis. It must be removed. The transfer of a proximal epiphysis of the fibula will rebuild the joint and will allow to continue growing from growth cartilage.


Figure 11B. After removing the proximal femur, we conduct a reconstruction which includes a femur allograft that will support the proximal vascularized fibular graft.


Figure 11C. 20 months after surgery, the fibular graft has increased enormously and has been transformed into a femur. This remodeling process still continues.

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