Reconstruction of humeral diaphyseal non-unions with vascularized fibular graft

Objective: The aim of this study was to review the results of 5 diaphyseal non-unions reconstructed using vascularized fibular grafts.Methods: This study included six non-unions (3 males and 3 females; average age: 47 years; range: 21 to 57 years) reconstructed using vascularized fibular grafts between 2002 and 2007. Average duration of non-union was 59 (range: 12 to 156) months. Fixation was achieved with intramedullary nailing in 3 patients and plates in 3. One case was lost to follow-up at the third postoperative month. The remaining five patients were followed up for an average of 37 (range: 12 to 53) months.Results: In four cases, union was achieved with a single operation at an average of 4.4 months. A secondary intervention for grafting was required for one patient for inadequate consolidation of the proximal bone-graft interface. Mean radiographic humeral length difference was 3.6 (range: 1 to 7) cm.Average elbow range of motion was 130 (range: 100 to 145), shoulder flexion 167.5 (range: 165 to 170), shoulder abduction 172.5 (range: 170 to 180), internal rotation 75 (range: 70 to 80), and external rotation 92.5 (range: 80 to 100) degrees. Mean DASH score was 10 (range: 5 to 19). According to the Tang system, 3 patients had excellent and 2 good clinical evaluations. Radiologic evaluation revealed four excellent and one fair result. No donor site morbidity was detected.Conclusion: Our results suggest that vascularized fibular grafting is an effective treatment option for the reconstruction of humeral diaphyseal non-unions.