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  • Title: Forearm as a valuable source of vascularized bone graft for the distal humerus.
    Author: Kamrani RS, Farhadi L, Farhoud AR.
    Journal: J Shoulder Elbow Surg; 2018 Mar; 27(3):435-443. PubMed ID: 29248257.
    Abstract:
    BACKGROUND: 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. METHODS: 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. RESULTS: 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. CONCLUSION: Vascularized bone flaps could be considered as an option to facilitate healing of distal humerus delayed union or nonunion.
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