‘Use of Pedicled Corticoperiosteal flap in resistant cases of distal femur non-union - our learning experience’

Introduction Nonunion of distal femur is a complex problem with the added burden of poor bone stock, osteopenia and joint contracture. Various procedures are described ranging from osteosynthesis using auto/allograft, to use of mega prosthesis. Use of vascularized corticoperiosteal flap based on descending genicular artery and superomedial genicular artery is a new technique to provide living vascular graft for the nonunion site. Though few free corticoperiosteal flap reconstructions have been reported in the past for these distal femur nonunions, this flap has seldom been used as a pedicled variety. Through this article we aim at highlighting the main obstacles faced while using pedicled Corticoperiosteal flap for these patients given its dearth in literature. Materials and Methods Five patients of at least two previously failed osteosynthesis for distal femur fracture non-union were selected for performing corticoperiosteal flaps. The intraoperative findings that were both favourable or unfavourable were documented along with the outcome of procedure in the form of callus formation or fracture healing. Results Dissection of the flap was more tedious in these cases than when done for a different indication in a virgin territory. However, despite the previous trauma resulting in decreased pliability of their vessels, all flaps were viable at the end of procedure with favourable cosmetic and functional outcome. Conclusion Despite the complexities in flap harvest, use of the less morbid and technically easier ‘Pedicled corticoperiosteal flap' and osteosynthesis along with auto technique is a worthwhile option for retaining the native joint with favorable outcome in non-unions of distal femur.