Vascularized Medial Femoral Condyle Periosteal Bone Grafts in the Treatment of Long-Standing Non-Union

Vascularized periosteal bone grafts from the medial femoral supracondylar region are reliable and effective flaps for long-standing non-unions that have failed conventional treatment. The authors described 9 consecutive patients treated with these bone grafts at the Mayo Clinic from June 2003 to March 2005. Seven free transfers and 3 pedicled flaps were utilized for a total of 10 non-union sites (one patient had non-union at both the proximal and distal ends of a segment of allograft interposition). There were 4 males and 5 females treated, with the average age of the patient population at 50 years (21–64 years). The non-union sites were the femur (n =ߙ4), tibia (n =ߙ2), humerus (n =ߙ2), and clavicle (n =ߙ2), and were secondary to trauma (n =ߙ7), cancer extirpation (n =ߙ1), and a large defect after debridement for chronic osteomyelitis (n =ߙ1). The time period of non-union prior to the use of vascularized bone graft ranged from 13 months to 23 years (median: 30 months). Some form of traditional means of treatment, including staged debridements, antibiotic bead placement followed by rigid fixation with non-vascularized bone grafts, and/or postoperative bone stimulator usage were performed in all cases before finally utilizing the vascularized periosteal flaps.

Six non-union sites healed without complication at an average period of 4.8 months (4–7 months). One patient had good callus formation at 2 months; however, she was lost to follow-up. Three non-union sites ultimately failed to heal. The first case was secondary to failure of the free flap due to arterial thrombosis. This resulted in a below-knee amputation. The second case failed due to persistent infection at the non-union site. The third failure was attributed to complications secondary to chemotherapy and the overall poor medical condition of the patient. Seven of the 10 cases either healed with no complications or showed evidence of good callus formation, despite a history of long-standing non-union resistant to conventional treatment. The authors believe that vascularized periosteal bone grafts from the medial supracondylar region are excellent flaps for difficult to treat non-union cases.