Kamiel Nader, Moharram Ashraf N, Shaheen Ayman, Ezzat Mostafa, Ebeid Walid
Department of Orthopedic Surgery, Kasr Alainy, Cairo University, Cairo, Egypt.
BMC Musculoskelet Disord. 2025 May 15;26(1):483. doi: 10.1186/s12891-025-08644-6.
Recalcitrant bone nonunion is characterized by impaired biological potential at the fracture site due to diminished vascularity and loss of osteogenic cells, reducing the success rate of nonvascularized bone grafts. In cases of ununited fractures of the tibia and femur with minimal gapping, the medial femoral condyle (MFC) corticoperiosteal flap offers a promising solution. This study aims to evaluate the effectiveness of the pedicled MFC corticoperiosteal flap in achieving union in recalcitrant nonunion of the distal half of the femur. The secondary objective is to report complications associated with this technique.
Three male patients with recalcitrant nonunion of the distal half of the femur were included. The transposition ratio was calculated by dividing the distance between the medial femoral epicondyle and the nonunion site (DMEB) by the distance from the medial femoral epicondyle to the apex of the lesser trochanter (DMELT). Patients with a ratio greater than 0.5 were excluded. Each patient underwent adequate rigid fixation, followed by harvesting a pedicled MFC corticoperiosteal flap from the medial distal femur. The flap was rotated to cover the nonunion site and augmented with an iliac crest bone graft to fill residual gaps. Bony union was monitored through monthly X-rays and CT scans.
All three patients (average age 36.7 years) had recalcitrant nonunion, two cases being aseptic atrophic and one septic. Union was achieved in all patients (100% union rate), with an average time to union of 6.7 months. No mechanical failures were observed. Complications included saphenous nerve injury and seroma in one patient, and an incisional hernia at the iliac crest graft donor site in another.
The pedicled MFC-CP flap appears to be a feasible option for treating recalcitrant distal femur nonunion, with minimal donor site morbidity. However, larger studies are needed to confirm its efficacy.
顽固性骨不连的特点是骨折部位的生物学潜能受损，这是由于血管减少和成骨细胞丢失所致，从而降低了非血管化骨移植的成功率。对于胫骨和股骨未愈合骨折且间隙极小的病例，股骨内侧髁（MFC）皮质骨膜瓣提供了一种有前景的解决方案。本研究旨在评估带蒂MFC皮质骨膜瓣在实现股骨远端顽固性骨不连愈合方面的有效性。次要目的是报告与该技术相关的并发症。
纳入3例股骨远端顽固性骨不连的男性患者。转位率通过将股骨内侧髁与骨不连部位之间的距离（DMEB）除以股骨内侧髁至小转子尖的距离（DMELT）来计算。转位率大于0.5的患者被排除。每位患者均接受充分的坚强内固定，随后从股骨远端内侧获取带蒂MFC皮质骨膜瓣。将皮瓣旋转以覆盖骨不连部位，并用髂嵴骨移植填充残余间隙。通过每月的X线和CT扫描监测骨愈合情况。
所有3例患者（平均年龄36.7岁）均为顽固性骨不连，2例为无菌性萎缩性骨不连，1例为感染性骨不连。所有患者均实现了骨愈合（愈合率100%），平均愈合时间为6.7个月。未观察到机械性失败。并发症包括1例患者出现隐神经损伤和血清肿，另1例患者在髂嵴骨移植供区出现切口疝。
带蒂MFC - CP皮瓣似乎是治疗股骨远端顽固性骨不连的一种可行选择，供区并发症最少。然而，需要更大规模的研究来证实其疗效。
