Non-vascularised fibula grafts for reconstruction of segmental and hemicortical bone defects following meta- /diaphyseal tumour resection at the extremities

Abstract

BackgroundThe reconstruction of meta−/diaphyseal bone defects following bone tumour resection is challenging, and biological treatment options should be applied whenever possible, especially in benign lesions and early stage sarcomas. We aimed to evaluate the results of segmental (SR) and hemicortical reconstructions (HR) at the extremities using non-vascularised fibula grafts.MethodsWe retrospectively enrolled 36 patients who were treated with non-vascularised fibula reconstructions (15 SR, 21 HR) after bone tumour resection (15 malignant, 21 benign). All cases were evaluated regarding consolidation, hypertrophy at the graft-host junctions, and complications; moreover, the functional and oncological results were assessed. The mean follow-up was 8.3 years (2.1–26.6 years).ResultsPrimary union was achieved in 94% (SR 87%, HR 100%) of patients, and 85% (SR 81%, HR 88%) showed hypertrophy at the graft-host junction. The overall complication rate was 36% with 4 patients (11%) developing local recurrence. There was a significant correlation between the development of mechanical complications (fracture, delayed-/non-union) and a defect size of ≥12 cm (p = 0.013), segmental defects (p = 0.013) and additional required treatment (p = 0.008). The functional outcome was highly satisfactory (mean MSTS score 86%).ConclusionsDue to encouraging results and advantages (such as their remodelling capacity at the donor site), non-vascularised fibula reconstructions should be considered a valuable alternative treatment option for patients with hemicortical defects or segmental reconstructions of less than 12 cm in which no additional neo-/adjuvant treatment is necessary.

Is Non-Vascularized Fibular Grafting an Effective Choice in the Treatment of Upper Extremity Pseudarthrosis?

“…The Q-DASH score, by which functionality was assessed, was median 6.8 (2.28 to 29.50). Although satisfactory results were obtained in general (4,10,11), the patients stated that they had difficulty in washing their backs mostly. According to the LEFS score (mean 76.5±2.81) in which the lower extremity was used as a donor, all subjects regained their lower extremity functions almost completely at the end of the follow-up.…”

“…Lenze et al (10) reported a direct proportional relationship between union time and defect size. Furthermore, Lenze et al (10) also reported that the rate of mechanical complications was increased in NVFGs above 12 cm and Schuh et al (24) reported 10 cm. Thus, the use of vascularized grafts became more advantageous.…”

“…Therefore, the use of the Masquelet and Ilizarov techniques in upper-extremity bone defects is quite low (21,22). However, there is evidence in the literature that NVFGs may be integrating and remodeling into the host bone (10,11). For these cases, reconstruction with NVFGs can be performed successfully after short (<6 cm) segment resection (10,11).…”

“…Non-vascularized fibular grafts (NVFGs), which were introduced at the beginning of the twentieth century, have been used for biological reconstructions for almost 100 years (8). Because of low donor site morbidity, short operation time, and easy surgical technique, it is possible to reconstruct long bone defects of the upper extremity shorter than 6 cm using NVFGs with excellent functional and cosmetic results (9)(10)(11).…”

Functional outcome of non-vascularized fibula in gap non union

“…Lenze et al concluded that the procedure was a valuable procedure in defects less than 12 cm in length with an excellent union rate with minimum complications. 10 El-Sayed et al in a study of 12 patients with post traumatic bone defects, reported union in 11 cases (union rate of 92%) in an average period of 4 months. 11 They used plate and screws for upper limb defects and external fixators for tibia with cortico-cancellous bone graft along the entire length of fibular graft to augment graft uptake.…”