Reconstruction of humeral diaphyseal non-unions with vascularized fibular graft.
OBJECTIVE
The aim of this study was to review the results of 5 diaphyseal non-unions reconstructed using vascularized fibular grafts.


METHODS
This study included six non-unions (3 males and 3 females; average age: 47 years; range: 21 to 57 years) reconstructed using vascularized fibular grafts between 2002 and 2007. Average duration of non-union was 59 (range: 12 to 156) months. Fixation was achieved with intramedullary nailing in 3 patients and plates in 3. One case was lost to follow-up at the third postoperative month. The remaining five patients were followed up for an average of 37 (range: 12 to 53) months.


RESULTS
In four cases, union was achieved with a single operation at an average of 4.4 months. A secondary intervention for grafting was required for one patient for inadequate consolidation of the proximal bone-graft interface. Mean radiographic humeral length difference was 3.6 (range: 1 to 7) cm. Average elbow range of motion was 130 (range: 100 to 145), shoulder flexion 167.5 (range: 165 to 170), shoulder abduction 172.5 (range: 170 to 180), internal rotation 75 (range: 70 to 80), and external rotation 92.5 (range: 80 to 100) degrees. Mean DASH score was 10 (range: 5 to 19). According to the Tang system, 3 patients had excellent and 2 good clinical evaluations. Radiologic evaluation revealed four excellent and one fair result. No donor site morbidity was detected.


CONCLUSIONS
Our results suggest that vascularized fibular grafting is an effective treatment option for the reconstruction of humeral diaphyseal non-unions.
Hand Microsurgery Orthopaedics and Traumatology Hospital, İzmir, Turkey.
Tulgar
T
Toros
Kemal
K
Ozaksar
Tahir Sadik
TS
Sügün
Fuat
F
Ozerkan
D000328:Adult; D016025:Bone Transplantation; D018483:Diaphyses / Q000293:injuries / Q000601:surgery; D005260:Female; D005599:Fractures, Ununited / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D006810:Humeral Fractures / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011859:Radiography; D016059:Range of Motion, Articular; D055815:Young Adult