前腕開放性骨折後の遷延癒合に対する血管柄付き腓骨頭移植術を施行した1例

Free Vascularized Fibula Head Graft for Reconstruction to Treat Delayed Union after an Open Fracture of the Forearm. Case Report

　外傷性前腕開放骨折後の遷延癒合に対して，血管柄付き腓骨頭移植(以下FVFHG)を行った．その結果，手関節機能の再建に成功した1例を経験したので報告する．症例は55歳の男性である．バイクで走行中に転倒して受傷し，当院に搬送された．右前腕開放骨折(AO23-C3，Gustilo Type IIIA)の診断で，受傷当日に創外固定を設置した．受傷5カ月の時点で，遷延癒合と診断した．FVFHGを用いた橈骨関節面の再建を施行した．術後15カ月の時点で，右手関節の可動域は掌屈30°，背屈40°，回内70°，回外40°であり，腓骨頭の骨折や圧壊も認めていない．

　We report a case in which a free vascularized fibula head graft (FVFHG) was used for wrist reconstruction after infected delayed union.　The patient was a 55-years-old male who was injured in a motorcycle accident.　An open fracture of the right forearm was diagnosed, and we performed external fixation on the day of the injury.　Five months later we made a diagnosis infected delayed union, and reconstructed the distal radial joint with a vascularized fibula head graft.　Fifteen months after the final operation, the total range of the wrist joint was 70 degrees of flexion-extension and 110 degrees of supination-pronation.　There have been no complications includings fractures or collapse of the fibula head graft.