The use of free nonvascularized fibular graft in the induced membrane technique to manage post-traumatic bone defects.

Abstract

The aim of the present study is to assess the results of free nonvascularized fibular graft in the induced membrane technique to manage bone defects. Fifteen patients with segmental skeletal defects were treated by the induced membrane technique using free nonvascularized fibular graft. The ages ranged from 20 to 48years with an average of 32years. The cause of the defects was post-traumatic bone loss in all cases. The defects were located in the distal femur in nine cases, proximal tibia in two cases and middle third of the tibia in four cases. The defects ranged from 5 to 14cm with an average of 8cm. All cases were treated by the induced membrane technique in two stages. Autogenous cancellous bone graft and free nonvascularized fibular graft were used to fill the defect in the second stage of surgery. All cases healed without additional procedures after the second stage except in two cases. The time-to-bone union ranged from 4 to 13months with an average of 7months. After physiotherapy, all cases regained good range of ankle and knee movements except two cases. The complications included nonunion of the graft in two cases, deep wound infection in one case, and chronic pain along the iliac crest in one case. No cases were complicated by implant failure or refracture. The use of free nonvascularised fibular graft in the induced membrane technique reduces the time of healing and improves the final outcome.