Posterior Interosseous Artery Distal Radius Graft for Ulnar Nonunion Treatment

The aim of our study was to describe a dorsal distal radius vascularized bone graft pedicled on the posterior interosseous artery (PIA), and its clinical application in 2 cases of ulnar nonunion. We studied the surgical technique in 5 freshly injected cadavers. The 4th extensor compartment artery originates from the anastomotic arch between the posterior division of the anterior interosseous artery and the PIA and provides periosteal branches to supply the dorsal distal radius metaphysis. A 2-cm vascularized bone graft can be harvested from the radius, and dissection of the PIA enables a long pedicle with a wide arc of rotation able to reach the ulnar diaphysis. The approach is limited to the forearm and distal radius and has minimal donor morbidity.