Use of non-vascularized autologous fibula strut graft in the treatment of segmental bone loss

Lawal, YZ; Garba, ES; Ogirima, MO; Dahiru, I L; Maitama, MI; Abubakar, K; Ejagwulu, F S

doi:10.4103/1596-3519.76571

Cited by 43 publications

(36 citation statements)

References 9 publications

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“…24 In one study using non-vascularised free fibular graft for recurrent GCT of the distal radius, no wrist subluxation was reported. 25 In a series of 18 patients, 5 developed nonunion, owing to inadequate fixation of the fibular graft. 22 In 10 patients using free non-vascularised fibular graft for post-traumatic lower limb bone loss, the union rate was 100%.…”

Section: Discussionmentioning

confidence: 99%

Reconstruction of the Distal Radius with Non-Vascularised Fibular Graft after Resection of Giant Cell Tumour of Bone

Ghulam

Zaidi

2014

J Orthop Surg (Hong Kong)

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Purpose. To evaluate outcomes of wide resection and reconstruction of the distal radius with nonvascularised autogenous fibular grafts for giant cell tumour (GCT) of bone. Methods. Medical records of 7 men and 5 women aged 22 to 47 (mean, 31) years who underwent wide resection of the distal radius and reconstruction with non-vascularised autogenous fibular grafts for GCT of bone were reviewed. The mean length of the resected radius was 9 (range, 7-11) cm. The ipsilateral proximal fibula with a small portion of attached ligament was harvested. The articular surface of the graft was fixed to the scapholunate articular surface by Kirschner wires, and the ligament of the fibular head was sutured to the carpal ligaments. The graft was fixed to the proximal radius with a small dynamic compression plate. Iliac cancellous bone graft was added. Pain, instability, and functional status were assessed. Wrist joint movements were measured using a goniometer. The grip strength was measured.Reconstruction of the distal radius with nonvascularised fibular graft after resection of giant cell tumour of bone Journal of Orthopaedic Surgery 2014;22(3):356-9The operated and contralateral sides were compared. Results. The mean follow-up was 24 (range, 20-27) months. All patients achieved radiological union after a mean of 16 (range, 14-20) weeks. The mean active range of movement in the operated wrists was 32º dorsiflexion, 38º palmar flexion, 15º radial deviations, 12º ulnar deviations, 50º supination, and 60º pronation. Compared with the contralateral wrists, the operated wrists regained 60% of the function, with satisfactory grip strength, and normal finger and thumb movements and hand sensation. No patient had recurrence after 2 years. Two patients had minor dorsal subluxation, which was resolved with a wrist brace. Three patients had superficial infection, which was resolved with intravenous antibiotics and dressings. Two patients had peroneal nerve palsy, which recovered completely in 12 weeks. Conclusion. Non-vascularised fibular grafts for reconstruction of the distal radius after resection of a GCT of bone achieved good cosmetic and functional outcomes.

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Section: Discussionmentioning

confidence: 99%

Reconstruction of the Distal Radius with Non-Vascularised Fibular Graft after Resection of Giant Cell Tumour of Bone

Ghulam

Zaidi

2014

J Orthop Surg (Hong Kong)

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“…Like other authors, we fashioned the proximal end of the graft to fit inside the medullary canal of the recipient proximal fragment [4, 7]. The use of nonvascularized fibular strut grafts has been proven to be a reliable technique to reestablish bone continuity in segmental bone defects [1, 2, 4, 7, 12]. Many reconstruction procedures have been proposed to treat such conditions.…”

Section: Discussionmentioning

confidence: 99%

“…Complications when harvesting the fibular strut graft, such as common peroneal nerve damage, weakness of extensor hallucis longus, ankle instability, nonunion, and stress fracture have been reported [8, 12]. In order to prevent intraoperative problems during fibular harvest, it is important to preserve at least 5 to 6 cm of the proximal and the distal parts of the fibula [12, 14].…”

Section: Discussionmentioning

confidence: 99%

Use of Nonvascularized Autologous Fibular Strut Graft in the Treatment of Major Bone Defect after Periprosthetic Knee Fracture

Giordano

Coutinho

Miyahira

et al. 2017

Case Reports in Orthopedics

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We present the case of a patient who suffered a comminuted supracondylar periprosthetic femur fracture. The patient was an 86-year-old lady who suffered a minor fall at home and presented at our hospital with a right comminuted distal femur fracture around a total knee arthroplasty. The patient was submitted to a cruciate-sacrificing total knee replacement 6 years before at the same institution. Despite severe metaphyseal fragmentation and short distal fragment, the prosthesis was stable; thus, open fracture reduction and stabilization with internal fixation were performed. The surgical technique included the use of a nonvascularized autologous fibular strut graft as an augmentation technique in conjunction with double plating fixation. Clinically, patient presented a painless aligned knee 12 months after femur fixation, although she was not able to return to an independent level of activity. No pain involving the donor graft site was reported at the time of the most recent follow-up examination. This case study demonstrates the use of free nonvascularized autogenous fibular strut bone graft as an option to bridge major bone defects. This proved to be a relatively simple, not expensive procedure that can be done percutaneously and does not need high-quality training.

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“…6 Yajima et al treated 20 patients with large bone defects or established nonunion of the femur due to various causes by vascularised fibular grafts (mean length of the fibular grafts was 18.1 cm) achieving successful outcome in 19 of the patients. 7 They highlighted the need for special microsurgical techniques.…”

Section: Resultsmentioning

confidence: 99%

Reconstruction of complex distal femur open fracture with distal femoral locking plate and primary autologous free fibular graft

et al. 2017

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Background: Distal femur fractures are high velocity injuries which accounts for 7-10% of all femoral fractures. These injuries are complex injuries which are difficult to manage. Despite advances in techniques and implants, treatment remains a challenge, in many situations.Methods: We present a retrospective review of 8 cases, involved in high velocity road traffic accident who presented to emergency department at St. John’s Medical College, Bangalore, Karnataka, India between September 2011 to December 2015, with complex open fracture of the distal femur with bone loss. All were managed with initial wound debridement and skeletal traction. Subsequently fractured femur was reconstructed with distal femoral locking plate stabilization, along with autogenous non vascularised fibular graft and cortical-cancellous graft bridging the bone defect. Radiological union, functional outcome measured with Tegner and Lyslom scores, KOOS score and complications were assessed.Results: At average 5 years follow up, all the fractures have united well, with good functional outcome. X-ray showing united fracture with incorporation of the fibular graft. According to Tegner and Lyslom scoring, 6 patients had good rating, 2 had satisfactory rating. Average KOOS score was 82.15. Shortening of 2 cm and 4 cm in couple of patients was the major complication. Conclusions: Delayed primary surgery, using autologous non vascularised free fibular graft in conjunction with a locking compression plate, with autogenous cortico-cancellous graft is an effective, less technically demanding and cost effective means of reconstruction option to manage bone defects in complex open fractures of the distal femur. An overall acceptable results in terms of fracture union, fibular incorporation, adequate restoration of knee motion and early rehabilitation can be expected.

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Use of non-vascularized autologous fibula strut graft in the treatment of segmental bone loss

Abstract: Autologous free, non-vascularized fibula and cancellous graft is a useful addition to the armamentarium of orthopedic surgeon in developing countries attempting to manage segmental bone loss, whether created by trauma or excision of tumors.

Cited by 43 publications

References 9 publications

Reconstruction of the Distal Radius with Non-Vascularised Fibular Graft after Resection of Giant Cell Tumour of Bone

Reconstruction of the Distal Radius with Non-Vascularised Fibular Graft after Resection of Giant Cell Tumour of Bone

Use of Nonvascularized Autologous Fibular Strut Graft in the Treatment of Major Bone Defect after Periprosthetic Knee Fracture

Reconstruction of complex distal femur open fracture with distal femoral locking plate and primary autologous free fibular graft

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