Department of Orthopedics, Dr Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran.
Department of Orthopedics, Milad Hospital, Tehran, Iran.
J Shoulder Elbow Surg. 2018 Mar;27(3):435-443. doi: 10.1016/j.jse.2017.09.018. Epub 2017 Dec 18.
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.
肱骨远端骨折不愈合是一种具有挑战性的并发症。我们的目的是评估带蒂骨瓣应用治疗这种问题的效果。
有 6 名男性和 3 名女性患者因肱骨远端延迟愈合或不愈合而行 10 例手术治疗，其中 4 例行刚性固定加桡骨前臂或骨后骨瓣，5 例行针板固定。6 例行尺骨鹰嘴截骨术。
患者平均年龄 49.2 岁（范围 31-70 岁）。创伤与指数手术之间的平均间隔为 19.2 个月（范围 3-49 个月）。8 例肘部在放置骨瓣的柱内平均 3.75 个月（范围 3-6 个月）内愈合。1 例桡骨骨瓣未能愈合外侧柱的不愈合，需要额外的张力带固定。当桡骨骨瓣位于外侧柱时，2 例肘部的内侧柱未愈合。对于 1 例肘部，在另一次手术中在内侧应用另一个骨后骨瓣。平均随访 37.3 个月（范围 24-79 个月），视觉模拟评分的平均值从术后 6.44 显著改善至 2.22（P<.001）。 Mayo 肘部功能评分和 11 项残疾的手臂、肩膀和手评分也显示出临床和统计学上的显著改善。
带血管骨瓣可被视为促进肱骨远端延迟愈合或不愈合愈合的一种选择。
