Recalcitrant distal humeral non-union following previous Leiomyosarcoma excision treated with retainment of a radiated non-angiogenic segment augmented with 20 cm free fibula composite graft: A case report

Figure 1 Implant failure after intramedullary nailing. A: AP view of the right humerus after retrograde intramedullary nailing and implant failure; B: Lateral view with displaced distal fragment.

Figure 2 Second implant failure after ORIF. A: AP view of the right humerus shortly after revision using double plate fixation; B: Lateral view; C: AP view 14 mo after revision to ORIF; D: Lateral view showing implant failure.

Figure 3 Induced membrane technique. A: Intraoperative picture of the cement application to the humeral defect site after implantation of two nancy nails; B: Hardened cement used as a temporary space holder; C, D: AP and lateral X-ray after first surgery and implantation of two nancy nails.

Figure 4 Vascularized fibula graft and plate fixation. A: Vascularized fibula graft (VFG) after harvesting. B: Final plate fixation for stabilization of the VFG and bridging the defect. C, D: Lateral and AP X-ray after double plate fixation and combined vascularized fibular graft.

Figure 5 Final result. A: Final lateral X-ray after removal of one plate and osseous integration of the VFG; B: AP view with a good sight on the integrated VFG. VFG: Vascularized fibula graft.