Non-vascularized fibular graft in management of segmental bone defects: Study of twelve cases

Abstract

Segmental skeletal defects due to bone loss in comminuted open fractures and defects due to excision of sequestrated bone fragment in cases of osteomyelitis can be managed with staged treatment. Use of PMMA spacer beads or blocks mixed with appropriate heat resistant broad spectrum antibiotics to fill the bone defects has been practiced since decades. In the initial stage of bone defect management, these spacers along with external fixator to stabilize the injured lower extremity are of paramount importance.In second stage, fracture fixation with plates and using autologous cancellous bone grafts from the iliac crest to fill the skeletal defect is a standard practice all around the world. In large defects, addition of osteogenic autologous non-vascularized fibular graft and bone graft substitutes give superior results. In this study we evaluated the results in twelve cases of distal femur segmental bone defects due to trauma and osteomyelitis. We treated all cases with non-vascularized fibular strut grafts and cancellous bone grafts at the time of definitive fracture fixation. We obtained good results according to Functional Outcome Scoring System (FOSS) used to grade outcomes in open fractures of distal femur, in all the cases treated with this method.We conclude that use of non-vascularized fibular graft with cancellous bone graft in cases with segmental bone loss in distal femur, along with sturdy fixation is an excellent method for reconstruction of bone defects and leads to good results.