Reconstruction of Post-Traumatic Bone Defect of the Upper-Limb with Vascularized Fibular Graft

Fracture non-union or delayed union frequently occur after high-energy traumas associated to significant bony tissue loss, in open fractures with infections, and after an inappropriate use of internal fixation.1,2,3,4,5,6,7 Obesity, smoking, abuse of alcohol or drugs, osteoporosis and immunodepression are additional factors that prevent bone healing.1,4,6 Based on characteristic of the bone ends, non-unions may be atrophic, oligotrophic, and hypertrophic.8,9,10 Atrophic non-unions have little or no callus formation and are often characterized by bone resorption with normal healing, being limited by inadequate biological response at the fracture site. In turn, in oligotrophic and hypertrophic non-unions the blood supplies are adequate and abundant calluses are seen. In this case, the main reason for the non-union is an insufficient mechanical stability. Generally, the majority of non-unions are atrophic.11,12,13