The authors evaluated the outcomes in 5 patients with difficult non-unions of an upper extremity long bone who were effectively treated with rigid internal fixation and a vascularized corticoperiosteal graft from the medial femoral condyle. The patients had had between three and seven previous operations: 2 of the non-unions were associated with infection. Pain was relieved by 2 weeks, the bones healed within 3 months, 3 patients achieved a normal range of motion in the neighboring joint, and 2 patients obtained a functional range of motion. In 1 case, an infected hematoma developed at the donor site.
A small number of non-unions of long bones fail to heal by conventional means: stable internal fixation and non-vascularised bone grafting. The vascularised corticoperiosteal flap from the medial femoral condyle is one treatment option in this setting. The graft is wrapped around the opposite side of the non-union from the fixation plate with cancellous graft packed into the bone defect. The technique is complex, however, and the arterial pedicle may vary in length, necessitating an interpositional vein graft.
Non-union, Vascularized, Graft, Medial, Femoral, Condyle