Pedicled Vascularized Bone Graft Versus Induced Membrane Technique for Reconstruction of Forearm Medium-Size Bone Defects

Abstract

There is no financial information to disclose. Induced membrane technique has proven satisfactory results for reconstruction of infected nonunion. However, more complex techniques such as vascularized bone grafts (VBG) are usually indicated in the presence of prior graft failure or a poor soft tissue bed. The purpose of this study is to compare the clinical and radiological outcomes of a series of patients treated for ulnar nonunion with medium-size bone defects. Patients were treated with either pedicled distal radius VBG (Figure 68-1) or induced membrane technique (IMT). Twelve patients who underwent surgery for reconstruction of infected forearm nonunion with bone defects up to 6 cm (minimum follow-up, 2 years) were selected retrospectively. Seven patients underwent distal radius pedicled VBG (group A) and 5 patients underwent reconstruction with the induced membrane technique (group B) (Figure 68-2). Mean follow-up was 34 months. The time between the original injury and the index procedure was 16 months (range, 11–20). The mean age was 42 years (range, 26–64). Patients were evaluated clinically and radiographically. The number of previous surgeries was recorded. Elbow and wrist range of motion, visual analog scale (VAS) for pain, the Quick-DASH questionnaire, and Mayo Elbow Perfomance Score (MEPS) were assessed. Complications and the need for reoperations were recorded. All nonunion were healed at final follow-up. The average defect size was 5.3 cm (range, 4.2–6). The average number of previous surgeries in the VBG group was 4.2 (range, 3–7) and in the IMT group was 2.8 (range, 2–5). The average time to union was 3.8 months (range 3–6) for group A, and 4.6 (range 4–6) for group B. Active ROM did not differ significantly between groups. Average QuickDASH was 13, and average MEPS was 83. At the 2-year follow-up, there were no significant differences in the VAS pain score (1.3 in group A; 0.9 in group B). There were 2 complications. In the VBG group, one patient required implant removal, and in the IMT group, 1 nonunion required autogenous iliac crest bone graft. Final results were satisfactory for both. No fracture or persistent donor site pain was observed in the VBG group. •In this limited series, both techniques showed favorable results and could be considered surgical alternatives for the treatment of infected ulnar nonunion.•Pedicled VBG showed a shorter time to union compared with induced membrane.Figure 68-2Intraoperative photographs of an ulnar defect reconstructed with a pedicled radius VBG (A) and with iliac crest bone graft, during the second stage of the induced membrane technique (B).View Large Image Figure ViewerDownload Hi-res image Download (PPT)