Vascularized bone flaps for trauma induced bone defects of the upper extremity in young adults: Presentation of two cases

Abstract

Nonunions after complex upper extremity injury in young adults may result in diminished function, pain and decreased quality of life. The use of vascularized bone flaps is challenging. However, it offers the most bone healing stimulating properties in revision surgery. First, we describe the case of a young man with complex open wrist injury. He developed an osteoarthritis of the wrist, with abundant bone loss of the distal radius, ulna and carpal bones. He underwent wrist arthrodesis with the use of a vascularized iliac crest bone flap. Secondly, the case of a young woman is presented following a 4-part luxation fracture of the proximal humerus. She developed a nonunion with concomitant avascular necrosis. A reconstruction with plate fixation and a vascularized fibula flap was performed. In our cases, the use of vascularized autologous bone flaps resulted in union and a good clinical outcome. In literature, scarce evidence is present on the indications, procedure specifics, complications, clinical outcome, and patient related outcome measurements of the use of vascularized bone flaps for posttraumatic bone defects of the upper limb. This is likely due to the heterogeneity and scarcity of the patient population. The use of vascularized bone flaps is a viable treatment option for patients with complex nonunions of the upper extremity. • Impaired fracture healing of the upper extremity results in diminished functional outcome. • The use of vascularized bone flaps is an important option in revision surgery. • Vascularized fibula flaps and iliac crest flaps have good bone healing properties. • Osteoconductivity, osteoinductivity, osteogenicity and structural support determine the effectiveness of the graft.