Use of a Medial Femoral Epicondyle Vascularized Bone Graft in the Treatment of Pseudarthrosis of Limb Bones

Introduction: Objective: to determine the certain indications and evaluate the results of free vascularized bone grafting from the femoral medial epicondyle in the treatment of pseudoarthrosis and bone defects of the limbs.

Methodology and Material: for the period from June 2010 till September 2013 we used the free vascularized bone graft from the medial epicondyle of the femur in the treatment of scaphoid nonunion in 16 patients (14 men, 2 women) aged from 18 to 54 years old. Surgical treatment was performed in 14 to 58 month after injury. In all cases, nonunion was accompanied by an avascular necrosis of the proximal pole, and a significant humpback deformation, which led to advanced carpal collapse. Dimensions of the vascularized bone graft ranged from 1.1 × 0.8 × 1 cm to 1.5 × 1.2 × 1 cm. Mean length of the vascular pedicle was 3,3 ± 7,4 cm. In all cases both arterial and venous anastomoses were performed with a palm branch of the radial artery and its venae commitantes in an end-to-end fashion. Osteosynthesis was performed with compression screws and k-wires in 9 and 6 cases, respectively.

Results: results were evaluated according to radiographic, ultrasound (evaluation of vascular anastomoses), CT and MRI studies for the period of 2 months to 3 years. Comprehensive functional assessment was performed by a DASH questionnaire, active range of motion of the wrist joint, pain assessment by VAS scale, power grip and key pinch measurements. In 15 cases healing was achieved within 8 weeks postoperatively.

Conclusions: benefits of the vascularized bone grafts in treatment of a nonunion include a relatively rapid healing with possible revascularization of the necrotic bone. Medial femoral epicondyle provides an easily modifiable vascularized bone graft, massive enough to restore the length and shape of the scaphoid. Other advantages include minimal donor site morbidity, constant vascular anatomy and relatively simple harvesting technique. Treatment of the scaphoid nonunion using vascularized bone graft from the medial femoral epicondyle is fairly promising. This method allows to obtain not only the healing of nonunion in adequate term, but also to restore the carpal height.