Applications of the Vascularized Medial Femoral Condyle for Nonunion with Associated Bone Loss of the Foot: A Case Series
Applications of the Vascularized Medial Femoral Condyle for Nonunion with Associated Bone Loss of the Foot: A Case Series
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Category: Hindfoot, Midfoot/Forefoot Introduction/Purpose: Persistent nonunions with large bone defects continue to represent a challenging problem for foot and ankle surgeons.Vascularized corticocancellous grafts have been well described for various applications and represent a comprehensive solution to these difficult nonunion cases.We describe four cases of nonunions with concomitant large bony defects treated with a vascularized medial femoral condyle (VMFC).Methods: We retrospectively identified four cases of VMFC flaps used for foot nonunions with large bone defects.
Surgical indications included talonavicular nonunion with associated avascular necrosis of the navicular, talonavicular-cuneiform nonunion, navicular-cuneiform nonunion, and first metatarsophalangeal nonunion.All cases had large associated segmental bone defects.The average age at the time of surgery was 62-years-old.The tennessee vols boots average follow up was 2.
6 years (1.5-5.0).One patient had a remote history of tobacco use.
Another patient quit smoking pre-operatively and had normal nicotine metabolite levels at the time of surgery.There was one Type II diabetic.Results: ellakai Two patients underwent staged reconstruction with placement of an antibiotic cement spacer, but intra-operative cultures were negative.No patient had a previous infection.
The average graft dimensions were 3 x 2.25 x 1.5 cm.After obtaining adequate compression, all grafts were secured with bridge locking plates.
The average time to weight bearing was 14.5 weeks.All patients had knee pain post-operatively that resolved with time.Two patients required reoperation.
In one patient, the VMFC graft did not adequately fill the defect requiring supplement allograft.The VMFC-allograft interface went on to nonunion requiring tricortical iliac crest bone grafting.Another patient developed a split-thickness skin graft (STSG) infection requiring debridement and repeat STSG.There were no VMFC graft failures, and all patients went on to successful union.
Conclusion: Vascularized medial femoral condyle autografts are a technically demanding solution to difficult nonunion cases with significant associated bone loss of the foot.