Pedicled Vascularized Medial Femoral Epicondyle Bone Grafts for the Treatment of Femoral Shaft Nonunion

Abstract

We report 2 cases of femoral shaft nonunion that were successfully treated using pedicled vascularized medial femoral epicondyle bone grafts. Case 1 was in a 66-year-old woman with rheumatoid arthritis. Her roentgenograph demonstrated breakage of all 3 screws proximal to the fracture site 8 years after plate fixation with bone grafting, indicating femoral shaft fracture nonunion. Therefore, plate fixation was converted to intramedullary nailing and bone grafting with a pedicled vascularized medial femoral epicondyle bone. Case 2 was in a 36-year-old man. He exhibited nonunion of the femoral shaft for over 2 years after 2 surgeries for an open fracture. The intramedullary nail was replaced and grafting with a pedicled vascularized medial femoral epicondyle bone was performed. In both cases, bone union was uneventfully achieved within several months after the surgery. Pedicled vascularized bone grafting for the treatment of femoral shaft nonunion is indicated for patients with a lesion in the distal half of the femur. However, the length of the vascular pedicle may not be sufficiently long to reach the nonunion site. Thus, preoperative evaluation of the pedicle length using contrast-enhanced CT is recommended.