Abstract
Introduction: Nonunion is a known complication following fracture in the setting of radiotherapy. Free vascularized fibular (FVF) flaps have been used successfully in the treatment of segmental bone defects; however, their efficacy in the treatment of radiated nonunions is limited. The purpose of the study was to evaluate the outcome following FVFG for radiation-associated femoral fracture nonunions. Methods: 23 (11 male and 12 female; mean age 60 ± 12 years) patients underwent FVF for radiation-associated femoral fracture nonunions. The most common indication for radiotherapy was soft tissue sarcomas (n = 16). The mean follow-up was 5 ± 4 years. Mean radiation dose was 51 ± 14 Gy at a mean of 11 ± 3 years prior to FVF. The mean FVF length was 17 ± 4 cm and placed commonly with an intramedullary nail (n = 18). Results: First time union was 52% (n = 12) following additional bone grafting, the overall union was 78% (n = 18) at a mean of 13 ± 6 months. Musculoskeletal Tumor Society scores improved from 30% preoperatively to 73% at latest follow-up (p < 0.0001). Five fractures failed to unite; 3 were converted to proximal femoral replacements. Conclusions: FVF are a reasonable treatment option for radiation-associated femoral fracture nonunions, providing a union rate of 78% and an improvement in functional outcome. Level of Evidence: Therapeutic Level IV.
Original language | English (US) |
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Pages (from-to) | 1989-1994 |
Number of pages | 6 |
Journal | Journal of Plastic, Reconstructive and Aesthetic Surgery |
Volume | 73 |
Issue number | 11 |
DOIs | |
State | Published - Nov 2020 |
Keywords
- Femur
- Nonunion
- Radiation-associated fracture
- Union rate
- Vascularized fibular flap
ASJC Scopus subject areas
- Surgery