Forearm as a valuable source of vascularized bone graft for the distal humerus.

Abstract

The nonunion of a distal humeral fracture is a challenging complication. Our aim was to assess the results of the application of pedicled bone flap to treat this problem. There were 6 men and 3 women with delayed union or nonunion of the distal humerus treated by 10 procedures of rigid fixation plus radial bone forearm or posterior interosseous bone flaps. A locking plate was applied for fixation in 4 patients and a pin and plate for 5 patients. The olecranon osteotomy was performed in 6 elbows. Patients were a mean age of 49.2 years (range, 31-70 years). The average interval between the trauma and the index operation was 19.2 months (range, 3-49 months). Eight elbows showed union within an average of 3.75 months (range, 3-6 months) in the column where the bony flap was placed. The radial forearm bone flap failed to unite the nonunion of the lateral column of 1 elbow, and additional tension banding was required. Two elbows did not heal at the medial column when the radial forearm bone flap was located on the lateral column. For 1 elbow, another posterior interosseous bone flap was applied on the medial side in another session. By a mean follow-up of 37.3 months (range, 24-79 months), the mean of the visual analog scale demonstrated significant improvement from 6.44 postoperatively to 2.22 (P < .001). The Mayo Elbow Performance Score and 11-Item version of the Disabilities of the Arm, Shoulder and Hand score also showed clinically and statistically significant improvements. Vascularized bone flaps could be considered as an option to facilitate healing of distal humerus delayed union or nonunion.