A-004415.1 Vascularised corticoperiosteal grafts from the medial femoral condyle for difficult non-unions of the upper limb

2007 ◽  
Vol 32 ◽  
pp. 62-62
Author(s):  
F DEL
2007 ◽  
Vol 32 (2) ◽  
pp. 135-142 ◽  
Author(s):  
F. DEL PIÑAL ◽  
F. J. GARCÍA-BERNAL ◽  
J. REGALADO ◽  
H. AYALA ◽  
L. CAGIGAL ◽  
...  

Hand ◽  
2020 ◽  
pp. 155894472093029
Author(s):  
Matteo Guzzini ◽  
Domenico Lupariello ◽  
Giuseppe Argento ◽  
Leopoldo Arioli ◽  
Andrea Ferretti

Background: The aim of this study was to evaluate the morbidity and regeneration of descending genicular artery and bone on the donor site, the medial condyle of the femur, after harvesting the corticoperiosteal flap and to report the clinical, functional, and radiographic outcomes of the treatment of atrophic nonunions of upper limb with corticoperiosteal vascularized flap at 5-year follow-up. Methods: From January 2011 to January 2018, 36 patients (average age of 45.8 years) were enrolled and evaluated with clinical and radiographic follow-up (average time of 66 months). In 20 patients, magnetic resonance angiography was also performed preoperatively and postoperatively to investigate the fate of the descending genicular artery after harvesting the corticoperiosteal flap. Results: Radiographic evaluation demonstrated a success rate of 94.4% (average time of bone healing of 5.2 months). At the recipient site, clinical evaluation showed excellent results in 75% to 80% of cases, and at the donor site, no statistical differences were found between before and after surgery clinical condition. In all patients who underwent magnetic resonance imaging, images showed a complete recovery of the blood supply of the medial femoral condyle. Conclusions: Medial condyle corticoperiosteal flap represents a valid choice for the treatment of upper limb nonunions. This technique brings a very low morbidity on the donor site, with complete restoration of blood supply and bone tissue. The limit of this flap is its low mechanical support, which suggests performing this technique especially for the treatment of upper limb nonunions.


2013 ◽  
Vol 21 (11) ◽  
pp. 2584-2589 ◽  
Author(s):  
Takashi Suzuki ◽  
Sayaka Motojima ◽  
Shu Saito ◽  
Takao Ishii ◽  
Keinosuke Ryu ◽  
...  

2017 ◽  
Vol 22 (01) ◽  
pp. 23-28 ◽  
Author(s):  
Mark Henry

Background: Nonunion involving the metaphyseal region of the distal radius is exceedingly rare, usually involving co-morbidity. Patients that have failed multiple prior conventional surgical interventions represent an even more difficult subset to treat; this investigation examined the utility of a specially designed free vascularized medial femoral condyle flap consisting of a central structural block graft with an extended corticoperiosteal sleeve to wrap around the junctions. Methods: Six patients (5 males, 1 female) with a mean age of 52 years had failed to achieve union involving the distal radius metaphysis after a mean of 3.7 prior surgeries occurring over a mean period of 24 months. Comorbidities included smoking, alcoholism, chronic nutritional deficiency, and prior osteomyelitis. The unique descending genicular artery medial femoral condyle flap designed to address these patients consisted of a central structural block graft in continuity with an extended corticoperiosteal sleeve. The structural block filled the bone defect, and the corticoperiosteal sleeve wrapped around the bone junctions and the neighboring bone margins. The mean flap size was 5.3 (+/- 1.3) cm long by 4.5 (+/- 0.9) cm wide. Pre-operative to post-operative DASH scores were compared using the paired student’ s t-test, with p < 0.05. Results: All flaps achieved union at a mean of 6.8 (+/- 2.1) weeks following surgery, using the criteria of bridging trabeculae on all 3 radiographs: coronal, sagittal, and oblique. The mean pre-operative DASH score of 63 (+/- 10) was statistically significantly different compared to the mean post-operative DASH score of 18 (+/- 8). Conclusions: With few alternative solutions able to address this unique and difficult problem, the structural block of vascularized bone with the extended corticoperiosteal sleeve proved able to achieve a union that had failed multiple previous attempts and able to resist reactivation of infection, in a challenging group of patients with comorbidities.


2013 ◽  
Vol 34 (10) ◽  
pp. 1395-1402 ◽  
Author(s):  
Nicholas T. Haddock ◽  
Hassan Alosh ◽  
Mark E. Easley ◽  
L. Scott Levin ◽  
Keith L. Wapner

1997 ◽  
Vol 119 (4) ◽  
pp. 379-385 ◽  
Author(s):  
T. A. Martens ◽  
M. L. Hull ◽  
S. M. Howell

This study was conducted to validate a new in vitro method to expose the medial compartment of the knee to be used in subsequent studies aimed at examining the load bearing capabilities of medial meniscal allografts. The new method involves an osteotomy and reattachment of the medial femoral condyle. The primary hypothesis was that the new method does not alter tibio-femoral contact pressure and area. To validate this method, the baseline contact pressure of the intact medial compartment was measured using a new nondestructive procedure for inserting pressure measurement film into the intact medial hemijoint. A secondary and related hypothesis was that incising the coronary ligament, a destructive method used by previous investigators to position pressure measurement film, alters the normal tibio-femoral contact pressure. To test these hypotheses, Fuji Prescale pressure-sensitive film was used to measure both tibio-femoral contact pressure and area within the medial compartment of the (1) intact knee, (2) the knee after osteotomizing and reattaching the medial femoral condyle, and (3) the osteotomized knee with an incised coronary ligament, using seven cadaver specimens. Measurements were taken at a compressive load of approximately two times body weight with the knee in 0, 15, 30, 45 deg of flexion. No significant differences between the intact and osteotomized knee were detected. Likewise, no significant differences were observed between the osteotomized knee and the osteotomized knee with an incised coronary ligament. These results confirm the utility of the new method in exposing the medial compartment for manipulation and placement of medial meniscal allografts in future studies examining the load-bearing characteristics of meniscal allografts.


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