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J Reconstr Microsurg 2023; 39(07): 502-507
DOI: 10.1055/a-2004-2364
Original Article

Correlation between Risk Factors and Healing Times in Long Bone Nonunions Treated with Corticoperiosteal Flap from the Medial Femoral Condyle

Matteo Guzzini
1   Orthopaedic and Trauma Surgery Unit, A.O.U. Sant'Andrea, La Sapienza University of Rome, Rome, Italy
,
Davide Ciclamini
2   Hand Surgery and Reconstructive Microsurgery Department, CTO Hospital, A.O.U. Città della Salute e della Scienza, Turin, Italy
,
Leopoldo Arioli
1   Orthopaedic and Trauma Surgery Unit, A.O.U. Sant'Andrea, La Sapienza University of Rome, Rome, Italy
,
Paolo Titolo
2   Hand Surgery and Reconstructive Microsurgery Department, CTO Hospital, A.O.U. Città della Salute e della Scienza, Turin, Italy
,
Alessandro Carrozzo 
1   Orthopaedic and Trauma Surgery Unit, A.O.U. Sant'Andrea, La Sapienza University of Rome, Rome, Italy
,
Francesca Latini
1   Orthopaedic and Trauma Surgery Unit, A.O.U. Sant'Andrea, La Sapienza University of Rome, Rome, Italy
,
Bruno Battiston
2   Hand Surgery and Reconstructive Microsurgery Department, CTO Hospital, A.O.U. Città della Salute e della Scienza, Turin, Italy
,
Andrea Ferretti
1   Orthopaedic and Trauma Surgery Unit, A.O.U. Sant'Andrea, La Sapienza University of Rome, Rome, Italy
› Author Affiliations
Funding The authors received no financial support for the research, authorship, and/or publication of this article.
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Abstract

Background The rate of fracture nonunion varies depending on the anatomical site. Numerous procedures have been proposed to treat recalcitrant nonunions. The vascularized medial femoral condyle corticoperiosteal free flap (MFCCFF) is increasingly used in nonunions with small bone loss.

The percentage of success of the MFCCFF is high but the factors involved in delayed bone healing or failure of this technique or the contraindications are not described in the literature.

This multicentric study aims to identify and report the different factors involved in determining the time of bone healing in the treatment of atrophic nonunion of long bones with the vascularized medial MFCCFF.

Methods All patients who underwent vascularized medial MFCCFF from January 2011 to December 2020 for the treatment of recalcitrant atrophic nonunions of long bones. Patients were reviewed at 2 and 6 weeks, and 3, 6, and 12 months postoperatively and evaluated by physical and radiographic examinations and patient-reported outcome measures.

Results The final study population comprised 59 patients with a mean follow-up of 26.2 ± 7.6 months, a rate of bone healing of 94.9% with a mean radiographic bone healing time of 4.1 ± 1.3 months, and low morbidity of the donor site. Diabetes mellitus, a body mass index (BMI) ≥30 kg/m2, and ≥2 previous surgeries on the fracture site were factors predicting timing for bone healing at the multivariate analysis.

Conclusion This study demonstrates the MFCCFF as an effective and safe procedure for the treatment of the recalcitrant atrophic nonunion of long bones. An association was found between the lengthening of bone healing time and a high BMI, presence of ≥2 previous surgical interventions, and diabetes mellitus, indicating these comorbidities as risk factors (not absolute contraindications) for this microsurgical treatment. So, to our knowledge, the MFCCFF could be the first-choice treatment for atrophic nonunion of long bones.

Keywords

nonunion - surgery - corticoperiosteal flap

Authors' Contributions

M.G., D.C., and P.T. were responsible for recruiting patients and collecting data. L.A. and F.L. have interpreted the data and drafted the work. A.F. and M.G. made substantial contributions to the conception of the work. M.G., D.C., and B.B. have substantively revised the article. A.C. and L.A. were responsible for statistical analysis and interpretation of data. All authors also substantively revised the work and approved the submitted version. All authors read and approved the final manuscript.


Availability of Data and Materials

The database generated during and/or analyzed during the current study is not publicly available but is available from the corresponding author on reasonable request.


Ethical Approval and Consent to Participate

All patients gave valid, written consent to be enrolled in the study.




Publication History

Received: 13 March 2022

Accepted: 30 November 2022

Accepted Manuscript online:
28 December 2022

Article published online:
19 January 2023

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