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

Abstract

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.

Autoinjerto de peroné no vascularizado para el tratamiento de defectos óseos postraumáticos en falange de pulgar

“…El resultado final del uso de aloinjertos en el manejo de defectos óseos segmentarios está directamente relacionado con la técnica quirúrgica empleada en la toma del injerto y con la posterior aplicación de este en sitios con adecuada cobertura y vascularización. Se ha establecido que los injertos vascularizados requieren mayor tiempo para lograr una integración y su evolución satisfactoria dependerán fundamentalmente de los tejidos de cubrimiento 6,9 .…”

Jaw reconstruction with vascularized fibular flap: The 11-year experience among 104 patients

“…The titanium plate was removed (e) et al [16] had successfully repaired one ankle joint with a 15-cm non-vascularized fibular flap. Moreover, Giordano et al [19] also adopted a 21-cm non-vascular fibular flap to successfully repair the distal femoral condyle defect in an 86-year-old patient. All these successful cases mentioned above have indicated that it is feasible to reconstruct bone defects with the non-vascular fibula in clinical practice [20].…”

Reconstruction of mandibular defects using vascularized fibular osteomyocutaneous flap combined with nonvascularized fibular flap

“…Jeong et al (10) successfully repaired one ankle joint with a 15 cm NVFF. Giordano et al (13) harvested a 21 cm of NVFF and divided it into 9 cm and 12 cm approximately, which were then used to successfully repair the distal femoral condyle defect in a 86-year-old patient caused by a comminuted fracture of the distal femur. Compared with vascularized fibular graft, NVFF is associated with a certain risk of failure, but the above-mentioned successful cases also indicate that, it is feasible to the reconstruct bone defects using NVFF in the clinic (14).…”