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 60â¯±â¯12 years) patients underwent FVF for radiation-associated femoral fracture nonunions. The most common indication for radiotherapy was soft tissue sarcomas (nâ¯=â¯16). The mean follow-up was 5â¯±â¯4 years. Mean radiation dose was 51â¯±â¯14â¯Gy at a mean of 11â¯±â¯3 years prior to FVF. The mean FVF length was 17â¯±â¯4â¯cm and placed commonly with an intramedullary nail (nâ¯=â¯18). RESULTS: First time union was 52% (nâ¯=â¯12) following additional bone grafting, the overall union was 78% (nâ¯=â¯18) at a mean of 13â¯±â¯6 months. Musculoskeletal Tumor Society scores improved from 30% preoperatively to 73% at latest follow-up (pâ¯<â¯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.
Outcomes of free vascularized fibular flaps for the treatment of radiation-associated femoral nonunions