Free vascularized femoral condyle bone graft in treatment of tubular bone nonunions

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Abstract

Vascularised bone graft from femoral condyles — are relatively new method in treatment of bone nonunions, small bone defects and loss of articular cartilage. In this article experience of using of vascularized bone grafts from medial and lateral femoral condyles, operation technique and clinical cases with long-term results were described. In conclusion, authors generated basic indications for free vascularized bone grafts from femoral condyles.

About the authors

I. O. Golubev

N.N. Priorov National Medical Research Center of Traumatology and Orthopaedics; N.I. Peoples’ Friendship University of Russia

Email: iog305@mail.ru

MD., PH.

Russian Federation, Moscow; Moscow

I. A. Kukin

City Clinical hospital #13

Email: Doctor.kukin@gmail.com

MD

Russian Federation, Moscow

M. V. Merculov

N.N. Priorov National Medical Research Center of Traumatology and Orthopaedics

Email: mer-vika@mail.ru

MD

Russian Federation, Moscow

G. N. Shiryaeva

N.N. Priorov National Medical Research Center of Traumatology and Orthopaedics

Email: hand-clinic@mail.ru

MD

Russian Federation, Moscow

O. M. Bushuev

N.N. Priorov National Medical Research Center of Traumatology and Orthopaedics

Email: bushuev_oleg@mail.ru

MD

Russian Federation, Moscow

I. A. Kutepov

N.N. Priorov National Medical Research Center of Traumatology and Orthopaedics

Author for correspondence.
Email: kutepov_cito@mail.ru

MD

Russian Federation, Moscow

M. E. Sautin

European Clinic of Sports Traumatology and Orthopaedics

Email: msautin@gmail.com

MD

Russian Federation, Moscow

G. G. Balura

N.N. Priorov National Medical Research Center of Traumatology and Orthopaedics

Email: mailto.baliura.doctor@gmail.com

MD

Russian Federation, Moscow

A. R. Sarukhanyan

N.I. Peoples’ Friendship University of Russia

Email: annesr@mail.ru

postgraduate student

Russian Federation, Moscow

References

  1. Einhorn Т.А. The cell and molecular biology of fracture healing. Clin Orthop Relat Res. 1998;355(Suppl.):S7-S21.
  2. Von Rüden C., Morgenstern M., Hierholzer C., Hackl S., Gradinger F.L., Woltmann A., Bühren V., Friederichs J. The missing effect of human recombinant bone morphogenetic proteins BMP-2 and BMP-7 in surgical treatment of aseptic forearm nonunion. Injury. 2016;47(4):919-124. https://doi.оrg/10.1016/j.injury.2015.ll.038.
  3. Pihlajamäki H.K., Salminen S.T., Böstman O.M. The treatment of nonunions following intramedullary nailing of femoral shaft fractures. J Orthop Trauma. 2002; 16(6):394-402.
  4. Schmidmaier G., Moghaddam A. Long bone nonunion. Z. Orthop Unfall. 2015;153:659-676.
  5. Hackl S., Hierholzer C., Friederichs J. Long-term outcome following additional rhBMP-7 application in revision surgery of aseptic humeral, femoral, and tibial shaft nonunion. BMC Musculoskelet Disord. 2017; 18(1):342. https://doi.org/10.1186/ s 12891-017-1704-0.
  6. Bishop AT, Shin AY. Green’s Operative Hand Surgery. 7th Ed. 2015.
  7. Morsy M., Sur Y.J., Akdag O., Eisa A., El-Gammal T.A., Lachman N., Moran S.L. Anatomic and high-resolution computed tomographic angiography study of the lateral femoral condyle flap: Implications for surgical dissection. J Plast Reconstr Aesthet Surg. 2018 71( 1 ):33-43. https://doi.Org/10.1016/j.bjps.2017.08.012.
  8. Yamamoto H., Jones D.B. Jr., Moran S.L., Bishop A.T., Shin A.Y. The arterial anatomy of the medial femoral condyle and its clinical implications. J Hand Surg Eur Vol. 2010;35(7):569-574. https:// doi.org/10.1177/1753193410364484.
  9. Hertel R., Masquelet A.C. The reverse flow medial knee osteoperiosteal flap for skeletal reconstruction of the leg. Description and anatomical basis. Surg Radiol Anat. 1989; 11 (4):257-262.
  10. Sakai K., Doi K., Kawai S. Free vascularized thin corticoperiosteal graft. Plastic Reconstr Surg. 1991;87:290-298.
  11. Higgins J.P., Bürger H.K. Osteochondral flaps from the distal femur: expanding applications, harvest sites, and indications. J Reconstr Microsurg. 2014;30(7):483-490. https://doi. org/10.1055/s-0034-1372484.
  12. Iorio M.L., Masden D.L., Higgins J.P. Cutaneous angiosome territory of the medial femoral condyle osteocutaneous flap. J Hand Surg Am. 2012;37(5):1033-1041. https://doi.оrg/10.1016/j. jhsa.2012.02.033.
  13. Wong V.W., Burger H.K., Iorio M.L., Higgins J.P. Lateral femoral condyle flap: an alternative source of vascularized bone from the distal femur. J Hand Surg Am. 2015;40(10): 1972-1980. https:// doi.org/10.1016/j.jhsa.2015.06.106.
  14. Hamada Y., Hibino N., Kobayashi A. Expanding the utility of modified vascularized femoral periosteal bone-flaps: An analysis of its form and a comparison with a conventional-bone-graft. J Clin Orthop Trauma. 2014;5(1):6-17. https://doi.Org/10.1016/j. jcot.2014.01.002.
  15. Deng A.D., Innocenti M., Arora R., Gabl M., Tang J.B. Vascularized small-bone transfers for fracture nonunion and bony defects. Clin Plast Surg. 2017;44(2):267-285. https://doi.org/10.1016/j. cps.2016.11.005.
  16. Fei W., Danmou X., Dong R., Wei F., Eberlin K.R., Yan C., Wusheng K. Free vascularized medial femoral condyle corticocancellous flap for treatment of challenging upper extremity nonunions. J Reconstr Microsurg. 2015;31 (2): 124-131. https://doi. org/10.1055/s-0034-1390045.
  17. Mehio G., Morsy M., Cayci C., Sabbagh M.D., Shin A.Y., Bishop AT, Moran S.L, Carlsen В.Т. Donor-Site Morbidity and Functional Status following Medial Femoral Condyle Flap Harvest. Plast Reconstr Surg. 2018;142(5):734e-741e. https://doi.org/10.1097/ PRS.0000000000004886.
  18. Garretson R.B., Katolik L.I., Verma N., Beck P.R., Bach B.R., Cole В.J. Contact pressure at osteochondral donor sites in the patellofemoral joint. Am J Sports Med. 2004;32 (4):967-974. https:// doi.org/10.1177/0363546503261706.
  19. Hugon S., Koninckx A., Barbier O. Vascularized osteochondral graft from the medial femoral trochlea: anatomical study and clinical perspectives. Surg Radiol Anat. 2010;32:817-825. https://doi. org/10.1007/s00276-010-0629-1.
  20. Iorio M.L., Masden D.L., Higgins J.P. The limits of medial femoral condyle corticoperiosteal flaps. J Hand Surg Am. 2011;36(10): 1592- 1596. https://doi.org/10.1016/j.jhsa.2011.07.015.
  21. Hugon S., Koninckx A., Barbier O. Vascularized osteochondral graft from the medial femoral trochlea: anatomical study and clinical perspectives. Surg Radiol Anat. 2010;32:817-825. https:// doi.org/10.1007/s00276-010-0629-l.
  22. Son J.H., Giladi A.M., Higgins J.P. Iatrogenic femur fracture following medial femoral condyle flap harvest eventually requiring total knee arthroplasty in one patient. J Hand Surg Eur Vol. 2018:1753193418813687. https://doi.org/10.1177/1753193418813687.

Supplementary files

Supplementary Files
Action
1. JATS XML
2. Fig. 1.Stages of graft collection from the medial condyle BC (a-b). BC —femur

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3. Fig. 2. СТ data of the forearm 14 months after plastic surgery by the inner condyle of BC. CT — computed tomography; BC — femur.

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4. Fig. 3. X-rays of the forearm the day after surgery (a, b) and 3 months after surgery (c, d).

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