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J Hand Microsurg 2023; 15(02): 106-115
DOI: 10.1055/s-0042-1748783
Original Article

Multifactorial Analysis of Treatment of Long-Bone Nonunion with Vascularized and Nonvascularized Bone Grafts

Marco Guidi
1   Department of Plastic Surgery and Hand Surgery, University Hospital Zurich, Zurich, Switzerland
,
Matteo Guzzini 
2   Department of Orthopedics and Traumatology, S. Andrea Hospital, University of Rome “La Sapienza,” Rome, Italy
,
Carolina Civitenga
2   Department of Orthopedics and Traumatology, S. Andrea Hospital, University of Rome “La Sapienza,” Rome, Italy
,
Riccardo Maria Lanzetti
3   Department of Orthopedics and Traumatology, San Camillo - Forlanini Hospital, Rome, Italy
,
Bong-Sung Kim
1   Department of Plastic Surgery and Hand Surgery, University Hospital Zurich, Zurich, Switzerland
,
Inga Swantje Besmens 
1   Department of Plastic Surgery and Hand Surgery, University Hospital Zurich, Zurich, Switzerland
,
Martin Riegger
4   Department of Orthopedics and Traumatology, Lugano's Regional Hospital, Viganello, Switzerland
,
Stefano Lucchina
5   Hand Surgery Unit, Locarno Hand Center, Locarno's Regional Hospital, Locarno, Switzerland
,
Maurizio Calcagni 
1   Department of Plastic Surgery and Hand Surgery, University Hospital Zurich, Zurich, Switzerland
,
Dario Perugia
2   Department of Orthopedics and Traumatology, S. Andrea Hospital, University of Rome “La Sapienza,” Rome, Italy
› Author Affiliations Funding None.
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Abstract

Introduction The purpose of the study was to evaluate the results of treatment of the nonunion of long bones using nonvascularized iliac crest grafts (ICGs) or vascularized bone grafts (VBGs), such as medial femoral condyle corticoperiosteal flaps (MFCFs) and fibula flaps (FFs). Although some studies have examined the results of these techniques, there are no reports that compare these treatments and perform a multifactorial analysis.

Methods The study retrospectively examined 28 patients comprising 9 women and 19 men with an average age of 49.8 years (range: 16–72 years) who were treated for nonunion of long bones between April 2007 and November 2018. The patients were divided into two cohorts: group A had 17 patients treated with VBGs (9 patients treated with MFCF and 8 with FF), while group B had 11 patients treated with ICG. The following parameters were analyzed: radiographic patterns of nonunion, trauma energy, fracture exposure, associated fractures, previous surgeries, diabetes, smoking, age, and donor-site morbidity.

Results VBGs improved the healing rate (HR) by 9.42 times more than the nonvascularized grafts. Treatment with VBGs showed a 25% decrease in healing time. Diabetes increased the infection rate by 4.25 times. Upper limbs showed 70% lower infection rate. Smoking among VBG patients was associated with a 75% decrease in the HR, and diabetes was associated with an 80% decrease.

Conclusion This study reports the highest success rates in VBGs. The MFCFs seem to allow better clinical and radiological outcomes with less donor-site morbidity than FFs.

Keywords

iliac crest bone graft - nonunion of long bone - medial femoral condyle - vascularized bone grafts - vascularized fibular graft

Authors' Contribution

M.G. and M.G. researched literature and conceived the study. M.G., M.G., C.C., R.M.L., B.S.K., I.S.B., M.R., S.L., M.C., and D.P. were involved in protocol development, data analysis, and correction of the manuscript. M.G. wrote the draft of the manuscript. All authors reviewed and edited the manuscript and approved the final version of the manuscript.




Publication History

Article published online:
27 August 2022

© 2022. Society of Indian Hand Surgery & Microsurgeons. All rights reserved.

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