The free medial femoral condyle periosteal flaps for the treatment of recalcitrant upper limb long bones nonunion

BACKGROUND: Recalcitrant fracture non-union is a condition that is difficult to treat and may require multiple surgeries, some-times requiring treatment with periosteal flaps. The use of periosteal flaps can be preferred for the treatment of non-unions that do not yet have extensive bone defects. This study aims to share our experience with medial femoral condyle periosteal flap for the treatment of recalcitrant non-union in long bones of the upper limb.
METHODS: Seven patients who underwent treatment for upper limb non-union with a free medial femoral condyle periosteal flap be-tween 2015 and 2019 were retrospectively evaluated. Patients who had previously underwent implant revision and non-vascular grafting procedures and with failed atrophic non-union were included in the study. Non-union was in the humerus in two patients, ulna in three, radius in one, and clavicula in one patient. Demographic data, non-union features, complications, and radiographic findings of the patients were evaluated. Functional results were evaluated according to Quick Disabilities of Arm, Shoulder, and Hand (Q-DASH) scores.
RESULTS: Mean patient age was 41 (23–60) years and the mean follow-up time was 33 months (16–56). Non-union time ranged from 9 to 24 months. Additional surgical procedures were not required. One patient developed a hematoma in the donor site and required surgical drainage. Medial collateral ligament injury of the knee occurred in one patient. Union was observed in all patients in an average of 3 (2–7) months. Mean pre-operative Quick Disabilities of Arm, Shoulder, and Hand (Q-DASH) score was 56 (33–95), while mean post-operative control Q-DASH score was 5 (0–33); the improvement was statistically significant (p=0.017). The functional outcomes of all patients improved, as confirmed by Q-DASH score.
CONCLUSION: The medial femoral condyle periosteal flap offers a viable treatment option for recalcitrant non-unions. This flap has low comorbidity compared to other flaps and is a feasible option for revascularization and bone formation in atrophic non-unions.

Üst ekstremite inatçý kýrýk kaynamamasý tedavisinde serbest periostal medial femoral kondil flebinin kullanýlmasý

AMAÇ: Ýnatçý kýrýk kaynamamasý tedavisi zor, birden çok cerrahi gerektirebilen, bazen periost flepleriyle tedavi gerektirebilen bir durumdur. Periost flepleri kullanýmý henüz yaygýn olmayan kemik defekti bulunmayan kaynamalar için tercih edilebilen bir yöntemdir. Bu çalýþmanýn amacý, üst ekstremite uzun kemiklerin inatçý kaynamamalarýnýn tedavisi için medial femoral kondil periost flebi ile ilgili deneyimimizi sunmaktýr.
GEREÇ VE YÖNTEM: 2015–2019 yýllarý arasýnda üst ekstremitede kemik kaynamamasý olan serbest medial femoral kondil periosteal flep ile tedavi edilen yedi hasta geriye dönük deðerlendirildi. Daha önce implant revizyonu ve nonvasküler greftleme iþlemleri yapýlmýþ ve baþarýsýz olunmuþ atrofik kaynamama görülen hastalardan oluþmaktadýr. Bunlarýn ikisi humerus, üçü ulna, biri radius ve biri klavikula daydý. Hastalarýn demografik verileri, kay-namama özellikleri, komplikasyonlarý ve radyografik bulgularý deðerlendirildi. Fonksiyonel sonuçlar kol, omuz ve el skorlarýna göre deðerlendirildi. BULGULAR: Ortalama yaþ 41 (23–60), ortalama takip süresi 33 aydý (16–56). Kaynamama süresi 9–24 ay arasýnda deðiþiyordu. Ek cerrahi prose-düre gerek duyulmadý. Bir hastanýn donör bölgesinde hematom geliþti ve cerrahi drenaj gerektirdi. Bir hastada diz medial kollateral bað yaralanmasý meydana geldi. Hastalarýn hepsinde ortalama üç aylýk bir sürede (2–7) kaynama görülmüþtür. Ameliyat öncesi Q-DASH skoru 56 (33–95) ve ameliyat sonrasý kontrol Q-DASH skoru 5 (0–33) idi ve istatistiksel olarak anlamlýydý (p=0.017). Tüm hastalarýn fonksiyonel sonuçlarý, kol, omuz ve eldeki engellerle doðrulandýðý üzere iyileþmiþtir.
TARTIÞMA: Medial femoral kondil periosteal flep inatçý kaynamama durumlarýnda tercih edilen bir tedavi seçeneði sunar. Bu flep, diðer fleplere göre komorbiditesi düþük, atrofik kaynamamalarda yeniden kanlanma ve kemik oluþumu için uygun bir seçenektir.