Radial Reconstruction With Fibular Free Flap Using CAD-CAM and Virtual Surgical Planning in Pediatric Pseudoarthrosis due to Neurofibromatosis Type 1: A Case Report and Literature Review.

Neurofibromatosis type 1 (NF1) is an autosomal dominant disorder that causes skeletal dysplasia and congenital pseudoarthrosis of the forearm, which is very difficult to repair. The vascularized free fibular flap (FFF) is the standard treatment. CAD-CAM technologies and virtual surgical planning (VSP) offer greater precision and their full integration into primary pediatric reconstruction for NF1 is described. The objective of this case report is to present the simultaneous integration of all these tools in the primary reconstruction of a child with forearm pseudarthrosis due to NF1. We present the case of a 7-year-old boy with NF1 and radial pseudoarthrosis reconstructed using FFF, patient-specific CAD-CAM guides, and an interactive 3D VSP environment. A 3-cm defect was reconstructed using an FFF and a premolded LCP plate. Bone union was achieved at 7-8 months, with full range of motion in the wrist and nearly complete pronation-supination. No morbidity was reported in the donor site. This case reports the complete integration of FFF, CAD-CAM, and VSP in the primary reconstruction of a forearm pseudarthrosis in a child with NF1. LEVEL OF EVIDENCE: V Expert Opinion/Case Report.