Length of Vascularized Fibula Graft Utilized and Union: Is There a Relationship?

Abstract

Background Vascularized fibula grafting is used in the treatment of large skeletal defects, recalcitrant atrophic nonunions, and infected nonunions. Few studies have examined the factors contributing to nonunion of the graft at one or both graft–recipient junctions. The purpose of this study was to determine if a correlation exists between length of the graft and primary union of the graft–recipient interface at the proximal and/or distal junction. Methods A total of 21 patients who underwent vascularized fibula grafting from 2002 to 2014 for the treatment of skeletal defects were included. Radiographs were assessed for union of the graft at the proximal and distal junctions. The rates of union at the proximal and distal junctions were determined with respect to the limb and graft. The relationship between the length of graft utilized and union was assessed. Results A total of 71.4% of patients, with an average follow-up of 30.2 months, achieved complete union at an average of 8.7 months. With respect to the limb, a union rate of 95.2% was achieved at the distal graft–recipient junction versus 71.4% at the proximal junction ( p = 0.038). With respect to the graft orientation, a union rate of 90.5% was achieved at the distal graft versus 76.2% at the proximal graft ( p = 0.214). The length of the graft did not have a significant correlation to the rate of union. Conclusion The length of the fibula graft does not have an association with the rate of primary union. If primary union is not achieved, likely the nonunion will have occurred at the proximal graft–recipient junction.