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
