Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
European Orthopaedics and Traumatology
Published in: European Orthopaedics and Traumatology 3/2014

01-09-2014 | Original Article

Non-vascularized fibula and corticocancellous bone grafting for gap nonunion of lower limb—retrospective study of 18 cases—an age old technique revisited

Authors: B. Nataraj, V. Singh, A. C. Pathak, M. Jain, V. Khapane

Published in: European Orthopaedics and Traumatology | Issue 3/2014

Login to get access

Abstract

Purpose

The aim of this study was to evaluate the treatment of gap nonunion using non-vasularized fibula and corticocancellous bone grafting.

Methods

We analyzed 18 patients who had previously undergone a non-vascularized fibula strut and corticocancellous autograft procedure for gap nonunion of the lower limb. The mean gap was 5.9 cms, with 11 patients involving tibia gap nonunion and seven involving the femur. The mean age of the patients was 37.9 years, with a mean follow-up of 1.78 years. The patients underwent surgeries for femur nailing (static mode) and locking plates by standard technique using a standard lateral approach to the femur and tibia, respectively.

Results

The mean number of surgeries that each patient underwent was 3.17, with patients showing union at a mean of 15.8 weeks. Shortening was a common but acceptable complication, with the mean being 1.39 cms, along with three cases of failure.

Conclusion

The age-old method of non-vascularized fibula with autogenous corticocancellous bone grafting is a good method for treating nonunion, but patient selection as well as good bone grafting, rigid stability with an absence of infection, and good surrounding soft tissue vitality is mandatory for achieving success.
Appendix
Available only for authorised users
Literature
1.
Hertel R, Pisan M, Jacob RP (1995) Use of ipsilateral vascularised fibula for tibial reconstruction. J Bone Joint Surg Br 77(6): 914–919
2.
Wilson PD Jr (1972) A clinical study of the biomechanical behavior of massive bone transplants used to reconstruct large bone defects. Clin Orthop Res Relat 87:81–109CrossRef
3.
Yadav SS (1990) Dual fibular grafting for massive bone gaps in the lower extremity. J Bone Joint Surg Am 72:486–494PubMed
4.
Springfield D (1990) Autograft reconstructions. Orthop Clin North Am,1996 27:483–92
5.
Lee EH, Goh JC, Helm R, Pho RW Donor site morbidity following resection of the fibula. J Bone Joint Surg Br; 72:129–31.
6.
Enneking WF, Eady JL, Burchardt H (1980) Autogenous cortical bone grafts in the reconstruction of segmental skeletal defects. J Bone Joint Surg 62-A:1039–1058
7.
Shahab M, Seah M, Fragomen AT, Rozbruck R (2012) Femoral lengthening with lengthening over a nail has fewer complications than intramedullary skeletal kinetic distraction. Clin Orthop Relat Res 470:1221–1231CrossRef
8.
Hakan D, Mehmet K, Levent E et al (2012) Functional results of lower extremity lengthening by motorized intramedullary nails. Acta Orthop Traumatol Turc 46(1):42–49CrossRef
9.
Keating,Simpson,Robinson et al. (2005) The management of fractures with bone loss;J Bone Joint Surg [Br];87-B:142–50.
10.
Tuli SM (1972) Bridging of bone defects by massive bone grafts in tumorous conditions and in osteomyelitis. Clin Orthop Res Relat 87:60–73CrossRef
11.
Pho RWH, Levack B, Satku K, Patradul A et al (1985) Free vascularized fibular graft in the treatment of congenital pseudarthrosis of the tibia. J Bone Joint Surg 67-B:64–70
12.
Pacelli LL, Gillard J, McLoughlin SW, Buehler MJ (2003) A biomechanical analysis of donor-site ankle instability following free fibular graft harvest. J Bone Joint Surg 85-A:597–603PubMed
13.
Haw CS, O’Brien BM, Kurata T (1978) The microsurgical revascularization of resected segments of tibia in the dog. J Bone Joint Surg 60-B:266–269
14.
Gore DR, Gardner GM, Sepic SB, Mollinger LA, Murray MP (1987) Function following partial fibulectomy. Clin Orthop res relat 220:206–10
15.
Al-zahrani S, Harding MG, Kremli M, Khan FA, Ikram A, Takroni T (1993) Free fibular graft still has a place in the treatment of bone defects. Injury 24:551–554PubMedCrossRef
16.
17.
Onuba O (1988) Chronic osteomyelitis—Use of ipsilateral fibulargraft for diaphyseal defects of the tibia. Trop Geogr Med 40:139–142PubMed
18.
Mostafa E-S, Mahmoud E-H, Wael E-A (2007) Free non-vascularised fibular graft for treatment of post-traumatic bone defects. Acta Orthop Belg 73:70–76
19.
El Gammal TA, El-Sayed A, Kotb MM (2002) Hypertrophy after free vascularized fibular transfer to the lower limb. Microsurgery 22:367–70PubMedCrossRef
20.
Falder S, Sinclair JS, Rogers CA, Townsend PL (2003) Longterm behaviour of the free vascularised fibula following reconstruction of large bony defects. Br J Plast Surg 56:571–584PubMedCrossRef
21.
Malizos KN, Nunley JA, Goldner RD, Urbaniak JR, Herreison JM (1993) Free vascularized fibula in traumatic long bone defect and in limb salvaging tumour resection: Comparative study. Microsurgery 14:368–74PubMedCrossRef
22.
Chmell MJ, McAndrew MP, Thomas R et al (1995) Structural allografts for reconstruction of lower extremity open fractures with 10 centimeters or more of acute segmental defects. J Orthop Trauma 9:222–226PubMedCrossRef
23.
Vidyadhara S, Vamsi K, Rao SK, Gnanadoss JJ, Pandian S (2009) Use of intramedullary fibular strut graft: a novel adjunct to plating in the treatment of osteoporotic humeral shaft nonunion. Int Orthop 33:1009–14PubMedCentralPubMedCrossRef
24.
Fulkerson,Egol, Koval et al. (2006) Fixation of diaphyseal fractures with a segmental defect: a biomechanical comparison of locked and conventional plating techniques. J Trauma. Apr; 60 (4):830–5.
25.
Zwierzchowski H, Zwierzchowska D, Synder M (1989) The value of fibular autografts in block resection of bone tumours and tumour like conditions. Int Orthop 13:113–117PubMedCrossRef
26.
Garba, Lawal,Dahiru et al. (2011) Use of non-vascularized autologous fibula strut graft in segmental bone loss;Annals of African Medicine Vol. 10, No. 1:25–8.
Metadata
Title
Non-vascularized fibula and corticocancellous bone grafting for gap nonunion of lower limb—retrospective study of 18 cases—an age old technique revisited
Authors
B. Nataraj
V. Singh
A. C. Pathak
M. Jain
V. Khapane
Publication date
01-09-2014
Publisher
Springer Berlin Heidelberg
Published in
European Orthopaedics and Traumatology / Issue 3/2014
Print ISSN: 1867-4569
Electronic ISSN: 1867-4577
DOI
https://doi.org/10.1007/s12570-014-0254-2

Other articles of this Issue 3/2014

European Orthopaedics and Traumatology 3/2014 Go to the issue

Original Article

Periprosthetic bone mineral density after total hip arthroplasty with an AMIStem or Quadra femoral component performed by a minimally invasive anterior approach (AMIS): a prospective randomized clinical dual-energy X-ray absorptiometry study

Original Article

Does the peritumoral fat signal on MRI exclude malignancy of soft tissue tumor?

Original Article

Factors contributing to the failure of conservative treatment for acetabular labrum tears

Original Article

Thirty-six consecutive reverse shoulder arthroplasties in cuff arthropathy: our experience with the anterosuperior approach

Original Article

Clinical efficacy and cost-effectiveness of Clostridium histolyticum collagenase injections in a subpopulation of Dupuytren's contracture patients

Review Article

Biological internal fixation of comminuted femur shaft fractures by bridge plating in adults