Pedicled Vascularized Bone Graft of the Distal Radius for Recalcitrant Nonunion of the Distal Humerus

Abstract

Objectives: To analyze the clinical and radiological outcomes of a series of patients treated with a pedicled vascularized bone graft (VBG) of the distal radius for the treatment of recalcitrant atrophic nonunions of the distal humerus. Design: Retrospective clinical study. Setting: University-affiliated teaching hospital. Patients: Fifteen patients with supracondylar humeral atrophic nonunions with at least 3 previous failed surgical interventions were included. Intervention: Debridement of the distal humerus nonunion through a posterior elbow approach with provisional fixation was performed. Then, a pedicled VBG was harvested from the distal radius and tunneled back into the humeral bone defect. Iliac crest was used as needed, both for the nonunion and to stabilize the radius. Finally, definitive fixation with 2 locked plates was performed. Main Outcome Measurements: Radiological results, complications, elbow range of motion, Mayo elbow performance score, and subjective pain were evaluated. Results: There were 4 male and 11 female patients, with a mean age of 51 (range, 28–73) years. The mean follow-up period was 46 (range, 37–72) months with a minimum of 3 years. Radiological consolidation was achieved in all patients. Elbow range of motion was >100 degrees in 11 patients and between 50 and 100 degrees in 4 patients. Preoperative Mayo scores were poor in all patients. At final follow-up, Mayo scores were excellent in 3, good in 9, and fair in 3 patients. The mean postoperative visual analog scale score was 1.2 (range 0–3). Conclusions: Pedicled VBG of the distal radius was shown to be a reliable and effective alternative for the treatment of recalcitrant atrophic nonunions of the distal humerus, when other methods have failed. Level of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Double plating with autogenous bone grafting as a salvage procedure for recalcitrant humeral shaft nonunion

“…Osseous healing was defined as the presence of at least three of four healed cortices on plain radiography, and CT was not routinely performed unless it was difficult to judge healing on plain radiography [ 4 ]. The Mayo Elbow Performance Index (MEPI) was calculated preoperatively and at the most recent follow-up visit for each patient [ 17 ]. A MEPI score of 90–100 was considered an excellent result, 75–89 was considered good, 60–74 was considered fair, and less than 60 was considered poor.…”

Risk Factors for Non-Union after Open Reduction and Internal Fixation in Patients with Distal Humerus Fractures

“…Although distal humerus fractures account for a small percentage of all fractures [ 1 ], high complication rates have been reported after surgical treatment due to fracture complexity and poor bone quality [ 2 , 3 ]. It is reported that up to 25% of non-unions occur after distal humerus fracture surgery [ 4 , 5 ]; in most cases, further operative treatment with revision ORIF or total elbow arthroplasty is necessary [ 5 , 6 ]. Vauclair et al reported that when additional surgery is performed for non-union, a very high complication rate and unsatisfactory results may still occur [ 5 ].…”

Treatment of supracondylar humeral non-union by bone autograft and Hoffmann II external fixation

“…It is possible that a mix of 2/3 auto-and 1/3 allografts as reported by Karger et al [12] could also lead to bone healing, but this was not experimented in our cases. Vascularized bone or vascularized periosteal grafts, either pedicled as reported by Zaidenberg et al from the distal radius [17] or by microsurgical technique [18] are other options, possibly indicated in the case of poor soft tissue bed and large bone defect, but seem to be technically more challenging. Whatever type of bone grafting, we recommend a two-stage procedure according to Maquelet in the case of an active or suspected infection, which was the case only in one patient of this small series.…”