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Congenital pseudarthrosis of the forearm bones (CPFBs) is rare, with only 106 reported cases, and is frequently associated with neurofibromatosis (NF). Approximately 5% of patients with NF develop pseudarthrosis, and 50% of patients with pseudarthrosis have NF. Achieving bone union is difficult in congenital pseudarthrosis. Many methods have been attempted, including casting, internal fixation with or without grafting, and electrical stimulation, but failure is frequent. Free vascularized fibular flaps (FVFs) have been used to bridge long bone defects since 1975 and in tibial pseudarthrosis since 1979. In CPFB, FVF is more successful than other methods in achieving union and is the current treatment of choice. Here, we presented three cases of forearm pseudarthrosis treated with FVF, reviewed the literature on CPFB, and discussed some technical aspects of FVF treatment. Three cases of congenital pseudoarthrosis were treated with free fibula flaps, diagnosed at ages of 7 years (ulna), 15 months (radius), and 9 years (radius and ulna). Two flaps were stabilized with intramedullary wires and latterly, one with compression plates. One persistent nonunion received revision nonvascularized bone grafting and plating. All patients achieved union by 11 months after index surgery. Reconstruction with vascularized fibula is the treatment of choice because it offers the highest published union rates and good functional results. Complete resection of the affected bone and stable fixation, latterly with compression plates are critical to success. Surgery is technically demanding, and complications are common. Secondary surgery may be required, but outcomes are favorable. IV [ABSTRACT FROM AUTHOR]

Background: Free fibula flap (FFF) and medial femoral condyle (MFC) flap are commonly used for upper extremity osseous reconstruction, yet donor-site morbidity has never been systematically compared. Methods: Patients who underwent an FFF or MFC for upper extremity extra-carpal osseous reconstruction at 3 academic hand centers were retrospectively identified. Only patients who underwent reconstruction for a defect in which either flap type is routinely used or has been described in the literature were deemed eligible. Patients who agreed to participate were asked to complete the Lower Extremity Functional Scale (LEFS) and Lower Limb Core Scale (LLCS). The reported population norm median score of LEFS is 77 points. The LLCS population norm mean score is 90.52 points. Results: Twenty-one patients (10 MFC, 11 FFF) were enrolled. The median LEFS score for patients after MFC was 76 (interquartile range [IQR], 49-80) points and 75 (IQR, 56-79) points after FFF. The median LLCS score for patients after MFC was 96.4 (IQR, 87.9-100) points and 100 (IQR, 91-100) points after FFF. Median LEFS scores were slightly below the population norm, whereas median LLCS scores were above the norm for both FFF and MFC. All patients stated they would have the surgery again and that any dysfunction or pain in the leg was justified by the benefit in the arm. Conclusions: When considering whether to use an MFC or FFF for upper extremity reconstruction, both flap types appear to result in modest and comparable donor-site morbidity. [ABSTRACT FROM AUTHOR]

Background: Conventional techniques for fibular osteotomy planning are intrinsically erroneous. 3D-printed osteotomy guides are time-consuming, require expensive software, and cannot accommodate changes in surgical plan. This study evaluated the form, function, and esthetics of patients who underwent fibular reconstruction using a novel technique for osteotomy planning. Methods: Patients who required multi-segment fibular reconstruction of the mandible were enrolled. The unique 3D osteotomy guide was fabricated intraoperatively using wooden tongue depressors. Functional outcomes like the interincisal distance, occlusion, jaw deviation, and oral competence were measured at preoperative (T1), 1 month (T2), and 6 months post-op (T3). Esthetic outcomes assessed were facial symmetry and mandibular projection. The reconstructive accuracy was gauged by CT measurements of bigonial width, mandibular arch angle, and ramus length. Results: Thirty of the 61 patients met the inclusion criteria. The interincisal distance significantly improved from T1 to T2 and T3 (p < 0.001). The occlusion remained unchanged and oral competence was restored by T3. No discernible facial asymmetry or changes in mandibular projection were noted at T2 and T3. Bigonial width did not vary significantly (p = 0.573) from T1 to T2. The mandibular arch angles on the left (p = 0.573) and the right sides (p = 0.77) also did not differ significantly. Twelve patients underwent vertical ramus reconstruction, and no significant difference was noted between the normal and reconstructed sides at T1 and T2 (p = 0.339). Conclusions: This technique is simple, cost-effective, accurate, and requires no technical expertise. It minimizes the preoperative waiting period and allows flexibility in the ablative plan. Level of evidence: Level IV, therapeutic study. [ABSTRACT FROM AUTHOR]