title: Osteochondral flaps from the distal femur: expanding applications, harvest sites, and indications.
abstract: BACKGROUND
  The medial and lateral femur provide a source of convex osteochondral vascularized bone. The medial trochlea has been demonstrated to have similar contour to the proximal scaphoid, lunate, and capitate. Other sites of osteochondral harvest such as the posteromedial femur and the lateral trochlea are similar in morphology to the humeral capitellum and medial talus, respectively. These analogous structures offer potential solutions to difficult articular problems.
  
  
  METHODS
  Patients who underwent osteochondral reconstruction of the extremities were reviewed. These included 16 medial femoral trochlea (MFT) scaphoid nonunion reconstructions, 16 MFT Kienböck lunate reconstructions, 5 MFT capitate reconstructions, 2 lateral femoral trochlea osteochondral reconstructions of medial tarsal avascular necrosis, and 5 posteromedial femoral osteochondral reconstructions of the humeral capitellum for posttraumatic arthritis.
  
  
  RESULTS
  Computed tomography (CT) imaging demonstrated 15 of 16 reconstructed scaphoids achieving union. Follow-up wrist motion averaged 46.0 degrees extension and 43.8 degrees flexion, similar to preoperative measurements. CT imaging confirmed healing in 15 of 16 reconstructed lunates. Lichtman staging remained unchanged in 10 patients, improved in 4 patients (3A-2), and worsened in 2 patients (3A-3B). All but one patient experienced improvement in wrist pain. Wrist range of motion at follow-up averaged 50 degrees extension and 38 degrees flexion, similar to preoperative measurements. Capitate, talar, and capitellar reconstructions all resulted in achievement of osseous healing and restoration of joint alignment.
  
  
  CONCLUSIONS
  Vascularized osteochondral flaps provide a useful tool in the treatment of difficult articular problems in the extremities. Clinical experience thus far demonstrates a high rate of achieving union with acceptable range of motion and good pain relief.
authors.affiliation: Curtis National Hand Center, Baltimore, Maryland.
authors.forename: James P
authors.initials: JP
authors.lastname: Higgins
authors.affiliation: Private Hospital Maria Hilf, Klagenfurt, Austria.
authors.forename: Heinz K
authors.initials: HK
authors.lastname: Bürger
mesh_terms: D000293:Adolescent; D000328:Adult; D001178:Arthroplasty / Q000379:methods; D016025:Bone Transplantation / Q000379:methods*; D002356:Cartilage / Q000637:transplantation*; D005260:Female; D005269:Femur / Q000601:surgery*; D006801:Humans; D016268:Internal Fixators; D007866:Leg / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D059408:Pain Management; D016059:Range of Motion, Articular / Q000502:physiology; D019651:Plastic Surgery Procedures / Q000379:methods*; D013524:Surgical Flaps; D016896:Treatment Outcome; D014945:Wound Healing / Q000502:physiology; D014953:Wrist / Q000601:surgery*