Free Vascularized Fibular Graft vs. Ilizarov Method for Post-Traumatic Tibial Bone Defect

Abstract

From 1991 to 1996, four free vascularized fibular grafts (FVFG) and four callus distraction (CD) techniques were performed for post-traumatic tibial defects at the authors' institute. They attempted to discern any differences of results between FVFGs and CDs for post-traumatic tibial defects. The mean defect length of the FVFG and CD groups were 7.3 cm and 4.6 cm, respectively (p < 0.05). They selected as contributing factors: external fixation time, complication rate, hospital charge, union rate, and functional score (Puno's criteria), in order to compare the treatment of FVFG with that of CD. The external fixation times of the FVFG and CD groups were 176 days and 261 days, respectively. One septic non-union after refracture of the grafted fibula occurred in the FVFG group. Two non-unions (50 percent) at the docking site occurred in the CD group. The mean total costs of the FVFG and CD groups were 7,398,536 yen (US $68,505) and 11,798,153 yen(US $109,242), respectively. The union rates of both groups were 75 percent and 100 percent, respectively. The mean functional scores of both groups were 69.5 and 88.8 points, respectively. The functional results of the FVFG group were as follows: one patient showed good results; one, fair; and two, poor. The functional results of the CD group were as follows: two patients showed excellent results; one, good; and one, fair. Both the costs and the functional outcomes between the two groups did not significantly differ. No clear differences between the two treatment groups could be determined. However, many more cases are needed to establish statistically significant differences between both methods.

Acute peg in hole docking in the management of infected non-union of long bones

“…In the 39 bones that were docked in 36 patients, bone grafting was not required in any case. In studies carried out by Marsh et al, Yokoyama et al and Thirumal et al, additional procedures like bone grafting were required in 10, 50 and 50% of their cases, respectively [16,22,24]. The statistical difference with our series is significant.…”

Long bone reconstruction using multilevel lengthening of bone defect fragments

“…At present, the two prevailing methods for bone defect repair that provide vascular ties of the graft with the soft tissues are the Ilizarov non-free bone plasty and free vascularized grafts. They are considered to be methods of choice, and the studies that compared the efficiency of these two methods stated that there were no great advantages between them in obtaining anatomic integrity or functional outcomes [12][13][14].…”

Successful Management of a Childhood Osteosarcoma with Epiphysiolysis and Distraction Osteogenesis

“…Yokoyama et al 16 used free vascularized fibular grafts to treat 4 patients with tibial bone defects and distraction osteogenesis to treat another 4. The mean defect length in the vascularized bone graft group was 7.3 cm; in the distraction group, it was 4.6 cm.…”

“…Reconstructive procedures include distraction osteogenesis 2 , autoclaved autogenous bone supplemented with a vascularized fibular graft 16 , and frozen allograft 13 . All of the relevant studies describe various complications, but no recurrences at the retained epiphysis.…”