The Modified Vilkki Procedure: Vascularized Metatarsophalangeal Joint Transfer to Reconstruct a Full-Length Radius in Type III Radial Hypoplasia

Suresh K. Nayar, Simo K. Vilkki, James Patrick Higgins, Ryan Katz

Research output: Contribution to journalArticle


Radial longitudinal deficiency is a spectrum of deformity ranging from thumb hypoplasia to a shortened or absent radius. Traditional treatments are hindered by recurrent deformity and disruption of future forearm growth. These deficiencies can be addressed by a Vilkki procedure in which a free second toe metatarsophalangeal joint is used to restore a radial column and provide viable physes for continued forearm growth. A classic Vilkki procedure positions the proximal toe metacarpal on the native ulna to create a Y-shaped one-bone forearm. We report a case of a modified Vilkki procedure in which a 2-bone forearm is created using the proximal toe metacarpal to reconstruct the entire radius. In patients with type III radial longitudinal deficiency with suitable residual radius length, the modified Vilkki procedure can allow reconstruction of a 2-bone forearm. This affords the patient correction of the pathoanatomy and the potential for balanced growth and pronosupination.

Original languageEnglish (US)
JournalJournal of Hand Surgery
Publication statusPublished - Jan 1 2019



  • Microvascular joint transfer
  • radial club hand
  • radial longitudinal deficiency
  • vascularized metatarsophalangeal joint transfer
  • Vilkki

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine

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