Clinical Application Of Free Medial Femoral Condylar Cortical Periosteal Flap In The Treatment Of Tibial Nonunion

Objective To investigate the clinical effect of the descending genicular corticoperiosteal free flap in the treatment of tibial nonunions.Methods From January 2014 to June 2018,6 cases of tibial nonunion were treated with the descending genicular corticoperiosteal free flap combined autologous cancellous bone transplantation in our department.They were 4 men and 2 women,aged from 40 to 48 years(average 44 years).The causes of injury were:3 cases of traffic accident,2 cases of heavy object injury and 1 case of mechanical injury.All the patients had atrophic nonunion after Gustilo iii fracture,and some of them had bone defect.The length of nonunion and bone defect was 1.0cm×1.0cm×3.0cm-6.0cm×4.0cm×3.0cm.The area of cortical periosteal flap was 2.0cm×2.0cm-3.0cm×6.0cm.One of them carried flap,which was a chimeric tissue flap.Vascular anastomosis:the descending genicular artery of cortical periosteum flap was anastomosed with the anterior tibial perforatingartery in 2 cases,the posterior tibial perforating artery in 2 cases,anastomosis with anterior tibial artery in 2 case.End-to-end anastomosis of descending genicular artery with vein with anterior tibial artery or posterior tibial artery.Fracture end fixation:2cases continued external fixation,2 cases changed to plate internal fixation,2 cases changed to intramedullary nail fixation.Results Bone healing was achieved in 5 patients after operation,and the fracture was still unhealed in 1 patient after 6 months follow-up.According to the evaluation criteria of Paley fracture healing,4 cases were excellent,1 case was good and 1 case was poor.Among 6 cases,5 cases could complete normal daily activities.One patient was unable to complete daily activities because the fracture was not healed.According to the Paley functional recovery evaluation criteria,excellent in 1 case,good in 4 cases,poor in 1 case.Conclusion The method of the descending genicular corticoperiosteal free flap in the treatment of tibial nonunions with hidden donor area,constant anatomy,simple operation can effectively improve the fracture union rate and shortens the patient treatment time,which is helpful to the early functional exercise of patients.It is worth popularizing and applying in clinic.