The Journal of Bone and Joint Surgery, Vol 72, Issue 4 486-494, Copyright © 1990 by Journal of Bone and Joint Surgery, Inc
Dual-fibular grafting for massive bone gaps in the lower extremity
SS Yadav
Department of Orthopaedic Surgery, Maulana Azad Medical College, New Delhi, India.
Fifty-two patients who had a tumor in the lower extremity (thirty-seven, a
giant-cell tumor and fifteen, a small osteosarcoma that had not
metastasized) had dual-fibular strut-grafting to bridge the osseous gap
resulting from excision of the tumor. The size of the gap ranged from nine
to twenty-four centimeters. The average time until union ranged from ten to
twenty months. The ipsilateral fibula was used in thirty-six patients and
both fibulae, in the remaining sixteen patients. Immediate reimplantation
and adequate fixation of the fibular graft to the proximal and distal ends
of the bone to be grafted, along with placement of a cuff of cancellous
bone at the host-graft junction and between the fibular struts, fostered
early union of the graft to the host bone. Insertion of Kirschner wires
inside these long grafts helped to maintain continuity of the graft when a
stress fracture occurred. Eight patients who had a non-union at one of the
host-graft sites and three who had a stress fracture had subsequent
cancellous bone-grafting to obtain union. Superficial infection was the
most common complication and was seen in seventeen patients.
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