Autogenous Fibular Graft Research Articles

A surgical guide for identifying the lateral femoral circumflex vessels during free vascularized fibular transfer for avascular necrosis of the femoral head.

Free vascularized fibular transfer for avascular necrosis of the femoral head was developed in an attempt to preserve, rather than replace, the femoral head. In this procedure, the peroneal vessels of the autogenous fibular graft are anastomosed to recipient branches of the lateral femoral circumflex vessels. A problem with this procedure has been the difficulty in locating the lateral femoral circumflex vessels. An anatomic and surgical study was conducted to seek a consistent anatomic landmark for use in isolating these vessels. Ten cadaveric and 29 surgical hip dissections were performed. A falx, or fascial band, was consistently found approximately 10 cm distal to the anterior superior iliac spine; it is attached to the anterior intertrochanteric line of the proximal femur, with additional attachments to the investing fascia of the tensor fascia lata and rectus femoris muscles. Cautious release of this falx from superficial to deep leads to the fat layer surrounding the lateral femoral circumflex vessels. This study has shown that an anatomic landmark exists, which consistently leads to location of the lateral femoral circumflex vessels during a free vascularized fibular transfer. By incorporating the use of this landmark ito the authors' surgical technique, they have significantly reduced surgical dissection time and have provided a safe method for isolating the recipient vessels during this challenging operation.

Aneurysmal Bone Cyst: the Role of Fibular Graft in its Treatment

Aneurysmal bone cyst is a relatively uncommon benign bone lesion for which curettage and cancellous bone grafting is a widely accepted method of treatment. This paper presents a report of eight patients with aneurysmal bone cysts; four in the humerus, three in the femur and one in the proximal phalanx of the index finger. Seven patients were treated by curettage and cancellous bone graft and one by autogenous fibular graft combined with cancellous allograft. Patients treated by cancellous bone grafting developed recurrence within a year. Three of these recurrent cysts were then treated by autogenous fibular graft combined with allograft. All four patients treated by fibular graft showed satisfactory healing of the cysts with no recurrence at three years' follow-up. Analysis of these patients suggests that recurrence of the aneurysmal bone cyst is very frequent after curettage and cancellous bone grafting. It is recommended that where total excision of the cyst is not feasible, the treatment of choice should be curettage and autogenous fibular bone grafting combined with cancellous bone graft. Removal of the fibula form its middle third does not cause any disability and the fibula regenerates completely within a period of three months.

An Anterior Intradural Neurenteric Cyst of the Cervical Spine

The case of a cervical intraspinal neurenteric cyst in a 6-year-old boy is reported. The anterior intradural location of the cyst was confirmed by preoperative magnetic resonance imaging. Complete excision of the cyst was achieved through the anterior central corpectomy approach. The vertebral defect was reconstructed with autogenous fibular graft. The child made a complete neurological recovery without a mechanical problem either at the neck or at the graft donor site.

Resection arthrodesis of the shoulder with autogenous fibular bone grafts

We report the results of wide local excision of stage II8 proximal humeral tumors followed by reconstruction with parallel nonvascularized fibular bone grafts in three patients. Mean follow-up was 5 years (range 3 years to 8 years, 6 months). The pathologic diagnosis was osteogenic sarcoma in two patients and Ewing's sarcoma in one. The rotator cuff and deltoid were excised to achieve a wide margin around these tumors. All patients remain free from disease. They were able to return to previous work and sport activities. Two had a fracture of the graft; one fell from a mountain bike and the other fell at work. The former fracture united; the latter fracture required fixation and bone grafting to achieve union. By Enneking's 30-point functional evaluation, all three patients were in the excellent category with scores of 25, 26, and 28. We conclude that for the treatment of malignant tumors of the shoulder region with muscle involvement, excision followed by arthrodesis with parallel autogenous fibular bone grafts provides a method of retaining satisfactory upper limb function and acceptable cosmesis.

Reconstructive Amputation After Grade IIIC Open Tibial Fracture

A high percentage of patients with grade IIIC open tibial fractures eventually undergo amputation. Maintaining an adequate residual limb length is advantageous with regard to biomechanics, energy expenditure, and prosthetic fitting. This case report presents new considerations for maintaining residual limb length in the presence of comminuted proximal tibial fractures. These considerations include (a) using an autogenous fibular strut graft for stabilizing the reconstructed residual limb and (b) determining the level of amputation based on soft-tissue integrity rather than on fracture level. We present one technique for preserving an adequate residual limb length in the face of significant proximal tibia comminution.

Salvage Reconstruction in Acute and Late Sequelae from Pyogenic Thoracolumbar Infection

Nine patients treated surgically for complicated pyogenic osteomyelitis of the thoracolumbar spine are reported. All patients were treated with anterior debridement and stabilization with nonvascularized autogenous fibular strut grafts. In addition, seven underwent a posterior spinal fusion with instrumentation. The average length of follow-up was 25 months. There was no recurrence of infection, no pseudoarthrosis, and the fibular struts appeared incorporated in all patients. Seven patients had postoperative improvement or resolution of their back pain. The use of nonvascularized autogenous fibular strut grafts for reconstruction of the spine following debridement for vertebral osteomyelitis is an effective procedure. The advantages of using the fibula for grafting are its strength and length for spanning several vertebral segments, and it can provide multiple grafts.

Aneurysmal bone cyst in the metacarpal of a child: A case report

An unusual case of aneurysmal bone cyst in the metacarpal of a five-year-old girl is described. The lesion was initially diagnosed and treated as a simple bone cyst. Subsequently the affected metacarpal was excised and replaced by an autogenous fibular graft, with good results. A discussion of the pathogenesis of the lesion is given, with a review of the literature.

Nonvascularized fibular autograft to treat recurrent giant cell tumor of the distal radius

We report a 22-year-follow-up of a giant cell tumor treated by en bloc excision of the distal radius and replacement with an autogenous fibular bone graft. There has been no recurrence of the tumor. The patient has a good functional result and is free of pain except with extremes of wrist motion.

Application of free autogenous fibular graft in the treatment of aggressive bone tumours of the distal end of the radius.

Long-term results of the application of free autogenous fibular graft in the treatment of aggressive bone tumours of the distal end of the radius are presented. Six patients underwent radical resection of the tumour including the articular surface of the distal radius during the period 1969 to 1978, the average follow-up time being 5 years. In one case the tumour was low grade chondrosarcoma, in three cases a giant cell tumour grade two to three and in the remaining two a hemangioma. Five to twelve cm of the distal radius was resected and the defect was replaced using the ipsilateral proximal part of the fibula as free graft. Osteosynthesis was performed end to end with a plate fixation, or side to side with screw fixation. At follow-up, the range of motion in the radiocarpal joint was normal or close to normal in each case and all patients had returned to work within 6 months of the operation. None of the patients presented a recidive of the tumour.

Anterior fusion of the lumbar spine. End-result study with long-term follow-up.

We reviewed the cases of fifty patients who underwent anterior lumbar-spine fusion with autogenous fibular and iliac-bone grafts and were followed for two to fifteen years. Their diagnoses were instability of the spine, degenerative disc disease, pseudarthrosis, and spondylolisthesis. Fifty-six per cent had union and 44 per cent, non-union. Those who had iliac grafts healed in an average of 2.5 years and those who had fibular grafts, in 5.2 years. The clinical result was successful in twenty-six patients (52 per cent) and unsuccessful in twenty-four patients (48 per cent). Paradoxically, about one-half of the patients with clinical successes had a non-union and one-half of the failures had union. Retrograde ejaculation (sterility) did not develop in any of the men, and a survey of world authorities on anterior spine fusion revealed only sixteen patients with the sequela of retrograde ejaculation. The incidence of that complication has been exaggerated.

Treatment of Giant Cell Tumor in the Distal End of the Left Radius by the Total Excision and the Replacement with the Autogenous Fibular Graft

Treatment of Giant Cell Tumor in the Distal End of the Left Radius by the Total Excision and the Replacement with the Autogenous Fibular Graft