Between 1996 and 2016, we treated 36 cases of fracture nonunion and bone necrosis using free vascularized bone grafts from the medial supracondylar region of the distal femur. The nonunion cases consisted of 16 in the scaphoid, 6 in the forearm (3 each for the radius and ulna), 4 talar necrosis cases, 3 tibial nonunion cases, 3 in the lunate (Kienböck's disease), 2 humerus, and 1 each for the finger phalange and trochanter of the femur. All nonunion cases except three scaphoid cases achieved bony union. Two cases of talar necrosis healed completely. One talus healed with small collapse. The other talar necrosis cases had moderate collapse with osteoarthritis. Two Kienböck's disease cases healed with small collapse. The other developed severe collapse with osteoarthritis. We suggest that this procedure is good for patients with scaphoid nonunion, long bone nonunion with small bone defects, or talus necrosis. However, we do not recommend this procedure for patients with Kienböck's disease.
