Assessment of radiological outcomes in gap non-union of long bones using non-vascularised fibular strut graft augmented with corticocancellous graft

Abstract

Background: A prospective study was conducted in the department of Orthopaedics & Traumatology in Dr. D.Y Patil Hospital, Navi Mumbai from January 2015 to June 2017 to assess radiological outcomes in traumatic gap non-union of long bones after primary plate fixation failure using non-vascularised fibular strut graft augmented with corticocancellous graft. Methods: A total of 20 patients were included in study presenting with non-union of humerus. In 13 males and 7 females, age between 18-65 years (average 41 years), were operated using non-vascularized fibular strut graft taken from ipsilateral site augmented with auto corticocancellous graft. All the patients were operated by same surgeon with removal of previous plate and fixing with re-plating and intramedullary fibular grafting. The mean follow-up was 9 months (range 6-12 months). The patients were assessed for functional range of motion along with x-ray. Union was achieved after confirming on x-ray. Observations & Results: In study 20 patients there were 13 males and 7 females with average age being 41.35 yrs, average length of fibular graft was 6.3 cm and mean duration of union 21.15 weeks.1 patient was lost in follow up and none of patients showed non union or secondary intervention thus ensuring Bony union in all 20 patients treated with graft and plating Conclusion: This procedure successfully showed that union at nonunion site with adequate vascularity and good soft tissue coverage can be achieved with proper patient selection and using fibular graft in addition to traditional plating and CC graft technique. Even though procedure is lengthy but it’s simplicity, reproducibility and non expensive and patient compliant outcomes makes it a valid option to achieve union in nonunion.