Treatment of Persistent Non-Union of the Humerus Using a Vascularized Bone Graft from the Supracondylar Region of the Femur

Abstract

Six patients with recalcitrant post-traumatic humeral shaft non-unions were treated using vascularized bone grafts from the supracondylar region of the femur. The initial state of injury showed that four fractures were closed, while two were open fractures. At the acute stage, five fractures were fixed using intramedullary nailing, while one was fixed with a plate. In all patients, a bony flap was placed on the cortex after decortication. The size of the harvested bone flap ranged between 4 x 2.5 cm and 5 x 3 cm. After fixation of the bony flap, the inferior genicular artery and vein were anastomosed to the deep brachial artery and vein. The mean time required to obtain radiographic bone union was 3.3 months. The only graft-site complication involved transient mild paresthesia in the saphenous nerve area in one patient. This procedure was useful for atrophic nonunions without substantial bone defects of the humeral shaft.