Autologous non-vascularized fibula with compression plating in the management of aseptic complex non-union of long bones.

Abstract

The surgical treatment of non-union of long bones are challenging especially when bones are osteoporotic or there is a large bone gap due to repeated surgeries and implant failures. Plate with intramedullary fibula provides a stable construct as fibula acts as a second implant with better anchorage and high pull-out strength. The aim of our study is to present our experience of treating complex non-union of long bones using compression plating (LCPs/DCPs) in combination with autologous non-vascularized fibular graft (ANVFG). 10 cases of complex non-union of long bones (tibia, femur, humerus) treated with debridement, decortication followed by intramedullary fibular strut grafting and rigid osteosynthesis by LCPs/DCPs were included in this study. DASH score and LEFS score was used for upper limb and lower limb functional assessment. All patients had clinico-radiological union with a mean time of 11.4 months. Pre-operative mean DASH and LEFS score was 45.9±2.1 and 20.6±2.03 At the last follow-up, mean DASH and LEFS score was 19.8±1.1 and 60.6±2.6. Compression plating with ANVFG is a viable option for treating complex non-union of long bones. Intramedullary fibula acting as a second implant provides mechanical stability and support biological healing with its osteogenic property at the non-union site.