Free vascularized corticoperiosteal bone graft for the treatment of persistent nonunion of the clavicle

Radiation-induced necrosis or infection can result in a persistent nonunion of the clavicle. We describe 3 cases in which a free vascularized corticoperiosteal flap was harvested from the medial aspect of the femoral condyle and transferred to the fractured clavicle by use of microvascular anastomoses. Healing was confirmed by tomography in all 3 patients. The function of the upper extremity was remarkably improved at final follow-up. Vascularized free corticoperiosteal bone flaps are an option in clavicle fracture treatment. The technique of periosteal grafting is ideally suited to chronic nonunions with poor chances of healing on their own. Rapid subperiosteal new bone and improved local blood flow serve to correct many of those changes attributed to necrosis of bone.