Pedicled Vascularized Bone Graft from the Medial Supracondylar Region of the Femur for Treatment of Femur Nonunion

A free vascularized bone graft harvested from the supracondylar region of the femur was used to treat patients with nonunion but without a massive bone defect. This graft is vascularized by the descending genicular artery (DGA). In patients with femur nonunion, pedicled vascularized bone grafts are usable in some cases. To confirm the applicable range of this graft, we performed dissection of the DGAs in 16 lower limbs of eight embalmed cadavers. A pedicled bone graft from the supracondylar region of the femur was harvested and rotated proximally to the femur as far as possible. The distance from the apex of the medial epicondyle to the central point of the transferred bone (DMEB) was measured. DMEBs ranged from 13.0 to 20.0 cm (mean, 17.3). Dividing the DMEB by femoral length we defined as the transposition ratio. Transposition ratios ranged from 0.48 to 0.70 (mean, 0.60). These results showed we could transfer enough graft to a distal half of the femur. This technique has a good indication for intractable nonunion without significant bone defects of the distal half of the femur where conventional techniques are not practical.