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Free vascularised medial femoral condyle periosteal flaps in recalcitrant long bone non-union: a systematic review

  • Orthopaedic Surgery
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

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.

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Author notes

  1. Jamie Christina Weir and Rik Osinga have contributed equally to this manuscript.

Authors and Affiliations

  1. Canniesburn Plastic Surgery Unit, Glasgow Royal Infirmary, 84 Castle Street, Glasgow, UK

    Jamie Christina Weir, Rik Osinga & Steven John Lo

  2. Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital of Basel, Spitalstrasse 21, Basel, 4031, Switzerland

    Rik Osinga

  3. Blond McIndoe Laboratories, Institute of Inflammation and Repair, University of Manchester, Manchester, UK

    Adam Reid

  4. Department of Plastic Surgery and Burns, University Hospital of South Manchester, Manchester, UK

    Adam Reid

  5. Department of Radiology, Glasgow Royal Infirmary, 84 Castle Street, Glasgow, UK

    Giles Roditi

  6. Department of Trauma and Orthopaedic Surgery, Glasgow Royal Infirmary, 84 Castle Street, Glasgow, UK

    Angus Duncan MacLean

  7. College of Medical, Vetinary and Life Sciences, University of Glasgow, Glasgow, UK

    Steven John Lo

  8. Translational Research Center, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan

    Steven John Lo

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  1. Jamie Christina Weir
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Weir, J.C., Osinga, R., Reid, A. et al. Free vascularised medial femoral condyle periosteal flaps in recalcitrant long bone non-union: a systematic review. Arch Orthop Trauma Surg 140, 1619–1631 (2020). https://doi.org/10.1007/s00402-020-03354-1

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