Regeneration of the Fibula Using a Periosteum-preserving Technique in Children

Abstract

Bone grafting is a commonly used surgical procedure, particularly in reconstructive orthopedic surgery. Bone grafts may be used to fill skeletal defects created by trauma, infection, tumors, or congenital malformation. Fibular graft is an ideal option and is widely used to treat massive segmental defects; however, it leads to various complications, especially in children. This article describes our experience with donor site bone grafts using a periosteum-preserving technique with respect to minimizing donor site complications and performing effective reconstruction of bone defects in children. Seventeen patients who were followed after fibula resection and bone grafting in the donor site using a periosteum-preserving technique were evaluated radiologically and clinically. The patients were divided into 2 groups: 1 group was filled with cancellous allograft (n=9), and the other group was filled with calcium sulfate (n=8) in the donor site. Mean patient age was 8.4 years (range, 2-13 years), and mean follow-up was 31 months (range, 7-65 months). Complete regeneration of the donor sites occurred in all patients; mean time to regeneration at donor sites was 12 weeks (range, 4-21 weeks). There were no significant donor site complications intraoperatively or immediately postoperatively. The average regeneration index was 0.5 (range, 0.2-1.1), and it was found to increase with age (r=0.75, P<.001), indicating that younger patients had faster regeneration. The periosteum-preserving technique was found to lead to the reconstruction of bone defects effectively in children with minimal donor site complications.