title: "Half-folded" pedicled scapular bone flap for nonunion after humeral neck fracture: A case report.
abstract: Treatment of a nonunion of the proximal humerus remains a challenge because of the small proximal fragment and poor central cancellous bone stock of the humeral head. In this report, we describe our experience using a "half-folded" pedicled scapular bone flap with an anatomical locking plate to treat an atrophic nonunion of the proximal humerus in a 64-year-old right-handed woman. The patient had fallen and experienced a common humeral neck fracture 2.5 years previously. During the operation, we elevated the pedicled scapular bone flap, which measured 8.0 cm long and 1.5 cm wide, with a vascular pedicle about 10 cm long. We modified the bone flap to the half-folded type to fill the massive bone cavity in the humeral head. The proximal tip of the flap was divided into two segments while keeping the ventral soft tissue intact. The grafted bone bridging between the head and shaft of the humerus was rigidly fixed with a plate and screw. The operated shoulder was fixed with a sling and a chest belt for 3 weeks, after which the patient began active motion exercises of the shoulder joint. The flap survived without serious donor site morbidity, and good bone healing was obtained about 3.5 months after surgery. The patient was able to use the shoulder comfortably in daily activity without any serious donor site morbidity at 16 months after the surgery. This procedure may be effective in treating nonunion of the proximal humerus with a massive bone cavity in the humeral head.
authors.affiliation: Department of Orthopaedic Surgery, Obihiro-Kosei General Hospital, Obihiro, 080-0016, Japan.
authors.forename: Gen
authors.identifier: http://orcid.org/0000-0002-4896-0401
authors.initials: G
authors.lastname: Matsumae
authors.affiliation: Department of Orthopaedic Surgery, Obihiro-Kosei General Hospital, Obihiro, 080-0016, Japan.|Department of Orthopedic Surgery, Graduate School of Medicine, Hokkaido University, Sapporo, 060-8638, Japan.
authors.forename: Makoto
authors.identifier: http://orcid.org/0000-0002-6204-6229
authors.initials: M
authors.lastname: Motomiya
authors.affiliation: Department of Orthopaedic Surgery, Obihiro-Kosei General Hospital, Obihiro, 080-0016, Japan.
authors.forename: Naoya
authors.initials: N
authors.lastname: Watanabe
authors.affiliation: Department of Orthopedic Surgery, Graduate School of Medicine, Hokkaido University, Sapporo, 060-8638, Japan.
authors.forename: Norimasa
authors.initials: N
authors.lastname: Iwasaki
mesh_terms: D001858:Bone Nails; D001860:Bone Plates; D016025:Bone Transplantation / Q000379:methods*; D005260:Female; D000072039:Fracture Dislocation / Q000000981:diagnostic imaging / Q000601:surgery; D005593:Fracture Fixation, Internal / Q000295:instrumentation / Q000379:methods*; D005599:Fractures, Ununited / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods; D008875:Middle Aged; D016059:Range of Motion, Articular / Q000502:physiology; D020127:Recovery of Function; D018570:Risk Assessment; D012540:Scapula / Q000601:surgery; D012784:Shoulder Fractures / Q000000981:diagnostic imaging / Q000601:surgery*; D013524:Surgical Flaps / Q000098:blood supply / Q000637:transplantation*; D014057:Tomography, X-Ray Computed / Q000379:methods; D016896:Treatment Outcome