Free vascularised medial femoral condyle periosteal flaps in recalcitrant long bone non-union: a systematic review
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ORTHOPAEDIC SURGERY
Free vascularised medial femoral condyle periosteal flaps in recalcitrant long bone non‑union: a systematic review Jamie Christina Weir1 · Rik Osinga1,2 · Adam Reid3,4 · Giles Roditi5 · Angus Duncan MacLean6 · Steven John Lo1,7,8 Received: 23 September 2019 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Introduction In adults, treatment of recalcitrant long bone non-union is extremely challenging, with poorly vascularised and atrophic defects unresponsive to standard non-vascularised bone graft treatment. Recent studies have documented the use of free vascularised periosteal flaps to achieve union in refractory long bone fracture non-union, yet its use is not well established. This systematic review aims to assess the evidence for free vascularised periosteal flaps in recalcitrant long bone non-union. Materials and methods The MEDLINE®/PubMed® and Embase databases were searched for the Medical Subject Heading (MeSH) terms periosteal flap/vascularised flap/long bone/non-union/non united fracture in accordance with the PRISMA guidelines. Bibliographies were scrutinised for additional articles. Results Pooled data from 14 studies met the inclusions criteria, comprising 137 cases of non-union, with 117 relating to long bone non-union. Pooled data indicated an overall 99% (116/117) successful union rate. All studies were of mid- to low-level evidence (Level III, IV and V). Only one study directly compared vascularised periosteal flaps to non-vascularised bone grafts, showing union rates of 100% versus 80% and faster time to union (2 versus 5.5 months). Conclusions Free vascularised periosteal flaps are promising with pooled data showing a 99% success rate in achieving union in refractory long bone non-union. This compares favourably with standard orthopaedic care consisting of revision fixation and non-vascularised bone graft union rates of approximately 80%. However, study design flaws should be addressed by validated outcome measures plus adequate blinding, and further comparative studies with greater patient numbers are required. Keywords Free periosteal flap · Vascularised · Medial femoral condyle · Long bone · Non-union · Review
Introduction
Jamie Christina Weir and Rik Osinga have contributed equally to this manuscript. * Steven John Lo [email protected] 1
Canniesburn Plastic Surgery Unit, Glasgow Royal Infirmary, 84 Castle Street, Glasgow, UK
Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital of Basel, Spitalstrasse 21, Basel 4031, Switzerland
2
3
Blond McIndoe Laboratories, Institute of Inflammation and Repair, University of Manchester, Manchester, UK
4
Department of Plastic Surgery and Burns, University Hospital of South Manchester, Manchester, UK
In adult patients long bone fracture non-union occurs in 5–10% [1] and although it can often be managed with nonvascularised bone grafts, approximately 20% fail to resolve after a single attempt at revision fixation and bone grafting 5
Department of Radiology
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