The Denver Clinic was contacted regarding a man who had developed a nonunion and rotational deformity 3 months after he required surgical repair of fractures he sustained from a fall at his work on a construction site.  He had fallen 8 feet, breaking his lower leg bone and a bone in his foot.  He was taken to an area trauma center where he underwent surgical fixation of the fractures.  He was referred to the bone healing program for management of the nonunion and rotational deformity that had developed.

The following x-ray was taken when he arrived in the clinic.  He had significant bone loss, no evidence of bone formation at the fracture sites,and a rotational deformity of 15 degrees making it appear that his foot was not in-line with his leg. He also had a contracture (shortening) of his Achilles tendon so he was unable to place his foot flat on the ground.

X-ray showing intramedullary rod.

He was taken to surgery and the screws holding the rod were removed. The non-structural bone (wispy appearing on the x-rays) was surgically removed. In addition, his Achilles tendon was lengthened to allow him to be able to get his foot flat on the floor.

A few months later there were still no signs of bone forming in the area of nonunion so the Denver Clinic team determined that he would need a bone graft to the area. It was decided that a vascularized bone flap would provide the best chance of success for healing because it would be a live piece of bone that would be connected to the blood supply of the leg.

The plastic surgeon "harvested" a vascularized scapular bone flap from the patient's shoulder girdle. (The scapula is the bone that sits on the upper back and is often referred to as the shoulder blade.)

Scapular bone flap showing the soft tissue of the back over the shoulder blade, bone from the scapula, and blood vessels (loop on the right).

The bone flap was placed in the area of the nonunion. The soft tissue was used to reconstruct the skin over the tibia.

Bone flap held in place with screws. X-ray also shows a rod in the tibia.

The patient did well and the bone flap healed into the ends of the tibia.  He was able to return to work, driving for a construction company

CAT scan showing bone flap (top) that is healing into the tibia