Nonvascularized fibular grafts in the reconstruction of bone defects in orthopedic oncology

Abstract

Bone defects after resection or curettage of musculoskeletal tumors are commonly reconstructed with the use of structural fibular autografts or allografts with considerable success. In this study, we compared the clinical and radiographic results of nonvascularized autografts and allografts. Fifty-seven patients (30 males, 27 females; mean age 22.8 years; range 5 to 57 years) underwent reconstruction with a structural fibular autograft (n=30) or allograft (n=27) following tumor resection. Of the tumor defects, 24 were segmental and 33 were cavitary. All the patients who had segmental reconstruction were treated with internal fixation, except for one patient who had internal fixation and monolateral external fixator for femoral reconstruction. The results were evaluated with respect to union, time to union, and complications. The mean follow-up period was 46 months; 48.4 and 42.3 months in the allograft and autograft groups, respectively. Radiographically, union was obtained in 46 patients (80.7%) within a mean of 5.9 months (6.8 months in 20 autografts, and 5.1 months in 26 allografts). Nonunion (19.3%) occurred in four allografts and seven autografts. No significant difference was found between the two fibular grafts in terms of union (p>0.05). Graft rupture was detected in six patients (5 autografts, 1 allograft) all of which were due to minor traumas. Complications were encountered in eight patients (14%) including transient peroneal nerve injury (n=3), wrist subluxation (n=2), infection (n=2), and Madelung's deformity. Reconstruction of cavitary and segmental bone defects with autogenous or allogenous nonvascularized fibular grafts is a reliable method, with high success rates.