{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T14:49:34Z","timestamp":1787755774246,"version":"build-2784847793"},"reference-count":12,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"1","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"abstract":"<jats:sec>\n                    <jats:title>Case:<\/jats:title>\n                    <jats:p>A 48-year-old man with multiple injuries sustained a Gustilo type 3A right open distal humerus fracture with a 4-cm wound, contralateral radius shaft, and ilium fractures. Following wound irrigation on the day of injury, second look debridement showed crushed triceps and severe contamination extending into the distal humerus medullary canal. After 6 days of initial plate fixation, he developed signs of deep infection. Radical debridement twice resulted in a 10-cm bone defect, necessitating reconstruction with a Lambda-shaped free vascularized fibula for both columns.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>Lambda-shaped column reconstruction using free vascularized fibula flap yields satisfactory clinical and radiographic outcomes in metaphyseal distal humerus bone defects.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of evidence:<\/jats:title>\n                    <jats:p>V.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of clinical care:<\/jats:title>\n                    <jats:p>Level I Tertiary trauma center.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.2106\/jbjs.cc.24.00268","type":"journal-article","created":{"date-parts":[[2025,1,30]],"date-time":"2025-01-30T14:00:39Z","timestamp":1738245639000},"update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":2,"title":["Reconstruction of a 10-cm Defect in the Distal Humerus Using a Lambda-Shaped Free Vascularized Fibular Flap"],"prefix":"10.2106","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5007-3644","authenticated-orcid":false,"given":"Agraharam","family":"Devendra","sequence":"first","affiliation":[{"name":"Department of Orthopaedics and Trauma, Ganga Medical Centre and Hospitals Pvt, Coimbatore, Tamil Nadu, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5392-6056","authenticated-orcid":false,"given":"Asif","family":"Imran","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics and Trauma, Ganga Medical Centre and Hospitals Pvt, Coimbatore, Tamil Nadu, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1792-267X","authenticated-orcid":false,"given":"Hari","family":"Venkatramani","sequence":"additional","affiliation":[{"name":"Department of Plastic, Hand and Reconstructive Surgery, Ganga Medical Centre & Hospitals, Coimbatore, Tamil Nadu, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1509-0160","authenticated-orcid":false,"given":"Kannan","family":"Balaraman","sequence":"additional","affiliation":[{"name":"Department of Maxillofacial Surgery, Ganga Medical Centre & Hospitals, Coimbatore, Tamil Nadu, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1295-136X","authenticated-orcid":false,"given":"Jayaramaraju","family":"Dheenadhayalan","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics and Trauma, Ganga Medical Centre and Hospitals Pvt, Coimbatore, Tamil Nadu, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6043-006X","authenticated-orcid":false,"given":"Shanmuganathan","family":"Rajasekaran","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics and Trauma, Ganga Medical Centre and Hospitals Pvt, Coimbatore, Tamil Nadu, India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2025,1]]},"reference":[{"issue":"6","key":"bib1-20250130","doi-asserted-by":"crossref","first-page":"1040","DOI":"10.2106\/00004623-200306000-00008","article-title":"Unstable nonunions of the distal part of the humerus","volume":"85","author":"Ring","year":"2003","journal-title":"J Bone Joint Surg Am."},{"issue":"12","key":"bib2-20250130","doi-asserted-by":"crossref","first-page":"1090","DOI":"10.47102\/annals-acadmedsg.V38N12p1090","article-title":"Infected non-union of the humerus after failure of surgical treatment: management using the Orthofix external fixator","volume":"38","author":"Bassiony","year":"2009","journal-title":"Ann Acad Med Singap."},{"issue":"6","key":"bib3-20250130","doi-asserted-by":"crossref","first-page":"e20.00206","DOI":"10.2106\/JBJS.RVW.20.00206","article-title":"The basic science behind the clinical success of the induced membrane technique for critical-sized bone defects","volume":"9","author":"Littlefield","year":"2021","journal-title":"JBJS Rev."},{"issue":"suppl 2","key":"bib4-20250130","doi-asserted-by":"crossref","first-page":"111465","DOI":"10.1016\/j.injury.2024.111465","article-title":"Can locking plate fixation and free Vascularised fibular transfer with skin island achieve good functional outcome in the treatment of large bone defects of Tibia ? A study of 26 cases","volume":"55","author":"Dheenadhayalan","year":"2024","journal-title":"Injury."},{"issue":"10","key":"bib5-20250130","doi-asserted-by":"crossref","first-page":"e394","DOI":"10.1097\/BOT.0000000000001255","article-title":"Pedicled vascularized bone graft of the distal radius for recalcitrant nonunion of the distal humerus","volume":"32","author":"Zaidenberg","year":"2018","journal-title":"J Orthop Trauma."},{"issue":"5","key":"bib6-20250130","doi-asserted-by":"crossref","first-page":"e206","DOI":"10.1097\/BOT.0000000000002554","article-title":"Free vascularized fibula graft for staged reconstruction of infected humerus nonunions","volume":"37","author":"Lefebvre","year":"2023","journal-title":"J Orthop Trauma."},{"issue":"2 suppl","key":"bib7-20250130","first-page":"12","article-title":"Distal humeral septic non-union treated with debridement and vascularized fibular transfer: case report and review of the literature","volume":"23","author":"Bigoni","year":"2019","journal-title":"Eur Rev Med Pharmacol Sci."},{"issue":"3","key":"bib8-20250130","doi-asserted-by":"crossref","first-page":"378","DOI":"10.1097\/00006534-198803000-00011","article-title":"The \u201cdouble barrel\u201d free vascularized fibular bone graft","volume":"81","author":"Jones","year":"1988","journal-title":"Plast Reconstr Surg."},{"issue":"1","key":"bib9-20250130","doi-asserted-by":"crossref","first-page":"36","DOI":"10.1302\/0301-620X.79B1.0790036","article-title":"Free vascularised fibular grafting for reconstruction after tumour resection","volume":"79-B","author":"Hsu","year":"1997","journal-title":"The J Bone Joint Surg Br."},{"issue":"4","key":"bib10-20250130","doi-asserted-by":"crossref","first-page":"306","DOI":"10.1111\/os.12213","article-title":"Acute limb shortening for major near and complete upper extremity amputations with associated neurovascular injury: a review of the literature","volume":"7","author":"Kusnezov","year":"2015","journal-title":"Orthop Surg."},{"issue":"suppl 6","key":"bib11-20250130","doi-asserted-by":"crossref","first-page":"S53","DOI":"10.1016\/S0020-1383(16)30840-3","article-title":"Restoration of long bone defects treated with the induced membrane technique: protocol and outcomes","volume":"47","author":"Giannoudis","year":"2016","journal-title":"Injury."},{"issue":"suppl 3","key":"bib12-20250130","doi-asserted-by":"crossref","first-page":"40","DOI":"10.1016\/j.injury.2019.06.018","article-title":"Use of Masquelet technique in treatment of septic and atrophic fracture nonunion","volume":"50","author":"Raven","year":"2019","journal-title":"Injury."}],"container-title":["JBJS Case Connector"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.2106\/JBJS.CC.24.00268","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T13:50:48Z","timestamp":1787752248000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.2106\/JBJS.CC.24.00268"}},"subtitle":["A Case Report"],"short-title":[],"issued":{"date-parts":[[2025,1]]},"references-count":12,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2025]]}},"URL":"https:\/\/doi.org\/10.2106\/jbjs.cc.24.00268","relation":{},"ISSN":["2160-3251"],"issn-type":[{"value":"2160-3251","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,1]]}}}