Massive juxta-articular defects of the distal femur reconstructed by series connected double-strut free-vascularized fibular grafts

Liang, Kunneng; Cen, Shiqiang; Xiang, Zhou; Zhong, Gang; Yi, Min; Huang, Fuguo

doi:10.1097/ta.0b013e318216617b

Cited by 5 publications

(8 citation statements)

References 23 publications

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“…In some circumstances, additional procedures such as the change of a broken implant, compression in the nonunion site or cancellous graft in nonunion areas at bone ends, may be necessary and they raised the union rate to 98 % in published studies (Additional file 4) [15, 17–23, 25–31, 33–35, 39, 41, 42, 46–48]. …”

Section: Discussionmentioning

confidence: 99%

Autologous bone graft in the treatment of post-traumatic bone defects: a systematic review and meta-analysis

Azi

Aprato

Santi

et al. 2016

BMC Musculoskelet Disord

115

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BackgroundThis meta-analysis aimed to determine the bone union rate of bone defects treated with the different autologous bone graft techniques.MethodsThe PubMed and the Cochrane Library databases were searched using the terms: ‘fracture’ AND (‘bone loss’ OR ‘defect’ OR ‘defects’) AND ‘bone graft’, restricted to English language, to human species, and to a publication period from January 1999 to November 2014. Data were extracted by one of the reviewers and then checked by the second. A quality of evidence score and a methodology score were used. Heterogeneity was assessed. A random effects model approach was used to combine estimates.ResultsOut of 376 selected studies only 34 met the inclusion criteria. The summary pooled union rate was 91 % (95 % CI: 87–95 %) while union rate after additional procedures raised to 98 % (95 % CI 96–99 %). No association between union rate and bone defect size was found. (Univariable regression model: vascularized: P = 0.677; non-vascularized: 0.202. Multivariable regression model: vascularized: P = 0.381; non-vascularized: P = 0.226). Vascularized graft was associated with a lower risk of infection after surgery when compared to non-vascularized graft (95 % CI 0.03 to 0.23, p < 0.001).ConclusionThe results of this meta-analysis demonstrate the effectiveness of autologous graft for bone defects. Furthermore, from the available clinical evidence bone defect size does not seem to have an impact on bone union when treated with autologous bone graft techniques.Electronic supplementary materialThe online version of this article (doi:10.1186/s12891-016-1312-4) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Autologous bone graft in the treatment of post-traumatic bone defects: a systematic review and meta-analysis

Azi

Aprato

Santi

et al. 2016

BMC Musculoskelet Disord

115

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“…The use of bilateral FVFG for intercalary reconstruction of extensive femoral defects has been reported by several authors [7, 8, 12–14]. High rates of bone union with shorter nonweight-bearing duration are reported with this method.…”

Section: Discussionmentioning

confidence: 94%

“…The major problem with FVFG for femoral reconstruction is that single-strut FVFG cannot provide sufficient primary stability for femoral reconstruction [12]. The use of folded FVFG is reported to increase initial strength, but the available length is limited to 13 cm [7]. In this patient, the bone defect was 15 cm long, which exceeds the maximum available length of folded FVFG.…”

Section: Discussionmentioning

confidence: 99%

“…Liang et al performed bilateral FVFG for 16 patients with massive juxta-articular defects of the distal femur. They reported that primary bone union was achieved in 15 patients (93.8%) and eventual union in all patients (100%) [7]. Niethard et al performed bilateral FVFG for five patients with an oncologic femoral defect.…”

Section: Discussionmentioning

confidence: 99%

“…Of these, FVFG is the most suitable procedure because of its durability, bone-healing potential, and tolerance to infection [7]. However, the mechanical strength of single FVFG is not sufficient for femoral reconstruction and a stress fracture incidence rate of 7–16% has been reported [8].…”

Section: Introductionmentioning

confidence: 99%

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Simultaneous reconstruction of the bone and vessels for complex femoral defect

et al. 2016

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BackgroundSeveral methods have been reported for intercalary reconstruction of femoral defects. Of these, free vascularized fibula grafts (FVFG) are preferred because of their durability, bone-healing potential, and tolerance to infection. If the bone tumor invades the femoral vessels, simultaneous vascular reconstruction also becomes necessary and significant technical hurdles make limb salvage difficult.Case presentationWe present a 10-year-old girl who underwent limb-sparing surgery for a distal femur osteosarcoma. The femoral defect was 15 cm long, and the femoral vessel defect was 10 cm long. The femur was reconstructed with bilateral FVFG, and the femoral vessels were reconstructed with saphenous vein grafts. The grafts survived without vascular compromise, and the affected limb was preserved successfully.ConclusionsCombined use of bilateral FVFG and autologous vein grafts makes limb-sparing surgery for a large osteosarcoma of the femur possible.

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The Management of Bone Defects in Periarticular Knee Injuries: A Review Article

Buck

Murtha

2017

J Knee Surg

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Traumatic bone defects of the distal femur and proximal tibia present treatment challenges for the orthopaedic traumatologist. In addition to bone loss, significant soft tissue compromise and cartilage defects leave the patient and surgeon with few reconstructive options for proper long-term joint function. These injuries are often complicated by delayed healing, nonunion, malunion, infection, and poor subjective patient outcomes. There are a variety of clinical problems associated with the treatment of periarticular fractures about the knee. This article will describe the surgical options for these difficult problems.

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Massive juxta-articular defects of the distal femur reconstructed by series connected double-strut free-vascularized fibular grafts

Cited by 5 publications

References 23 publications

Autologous bone graft in the treatment of post-traumatic bone defects: a systematic review and meta-analysis

Autologous bone graft in the treatment of post-traumatic bone defects: a systematic review and meta-analysis

Simultaneous reconstruction of the bone and vessels for complex femoral defect

The Management of Bone Defects in Periarticular Knee Injuries: A Review Article

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