Free vascularized fibular grafts: radiographic evidence of remodeling and hypertrophy.

Lazar, Evelyn; Rosenthal, D I; Jupiter, Jesse B.

doi:10.2214/ajr.161.3.8352118

Cited by 38 publications

(27 citation statements)

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“…Various articles have reported hypertrophy incidence ranging from 38 – 90% 20–24. Reduced hypertrophy was seen when the graft was by-passed with internal fixation,23 but some authors found no difference in the hypertrophy with regard to the method of fixation 2021. When cancellous grafts were placed along the fibular graft no hypertrophy was seen after the cancellous graft ossified, due to stress shielding 24.…”

Section: Discussionmentioning

confidence: 99%

Vascularized fibular graft in infected tibial bone loss

Kovoor¹,

Jayakumar²,

George³

et al. 2011

IJOO

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Background:The treatment options of bone loss with infections include bone transport with external fixators, vascularized bone grafts, non-vascularized autogenous grafts and vascularized allografts. The research hypothesis was that the graft length and intact ipsilateral fibula influenced hypertrophy and stress fracture. We retrospectively studied the graft hypertrophy in 15 patients, in whom vascularized fibular graft was done for post-traumatic tibial defects with infection.Materials and Methods:15 male patients with mean age 33.7 years (range 18 - 56 years) of post traumatic tibial bone loss were analysed. The mean bony defect was 14.5 cm (range 6.5 – 20 cm). The mean length of the graft was 16.7 cm (range 11.5 – 21 cm). The osteoseptocutaneous flap (bone flap with attached overlying skin flap) from the contralateral side was used in all patients except one. The graft was fixed to the recipient bone at both ends by one or two AO cortical screws, supplemented by a monolateral external fixator. A standard postoperative protocol was followed in all patients. The hypertrophy percentage of the vascularized fibular graft was calculated by a modification of the formula described by El-Gammal. The followup period averaged 46.5 months (range 24 – 164 months). The Pearson correlation coefficient (r) was worked out, to find the relationship between graft length and hypertrophy. The t-test was performed to find out if there was any significant difference in the graft length of those who had a stress fracture and those who did not and to find out whether there was any significant difference in hypertrophy with and without ipsilateral fibula union. The Chi square test was performed to identify whether there was any association between the stress fracture and the fibula union. Given the small sample size we have not used any statistical analysis to determine the relation between the percentage of the graft hypertrophy and stress fracture.Results:Graft union occurred in all patients in a mean time of 3.3 months, at both ends. At a minimum followup of 24 months the mean hypertrophy noted was 63.6% (30 – 136%) in the vascularized fibular graft. Ten stress fractures occurred in seven patients. The mean duration of the occurrence of a stress fracture in the graft was 11.1 months (2.5 – 18 months) postoperatively. The highest incidence of stress fractures was when the graft hypertrophy was less than 20%. The incidence of stress fractures reduced significantly after the graft hypertrophy exceeded 20%.Conclusion:In most cases hypertrophy of the vascularized fibular graft occurs in response to mechanical loading by protected weight bearing, and the amount of hypertrophy is variable. The presence or absence of an intact fibula has no bearing on the hypertrophy or incidence of stress fracture. The length of the fibular graft has no bearing on the hypertrophy or stress fracture.

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Section: Discussionmentioning

confidence: 99%

Vascularized fibular graft in infected tibial bone loss

Kovoor¹,

Jayakumar²,

George³

et al. 2011

IJOO

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“…Although hypertrophy often occurs and can be seen on radiographs at an average of 18 months after surgery, hypertrophic bone fractures have been reported (Lazar et al 1993). A vascularized fibula graft in the leg should be protected against fatigue fracture during the first few years after implantation.…”

Section: Discussionmentioning

confidence: 99%

Reconstruction of tibia by ipsilateral vascularized fibula and allograft: 12 cases with malignant bone tumors

Ozaki

Hillmann

Wuisman

et al. 1997

Acta Orthopaedica Scandinavica

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“…17,[37][38][39][40] Hypertrophy is more common when the limb is mechanically loaded. De Boer et al found hypertrophy in 43 % of the mechanically loaded lower extremities and in only 20 % of the upper extremities.…”

Section: Discussionmentioning

confidence: 99%

Iliosacral Resections of Pelvic Malignant Tumors and Reconstruction with Nonvascular Bilateral Fibular Autografts

Wang¹,

Tang²,

Xie³

et al. 2012

Ann Surg Oncol

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Free vascularized fibular grafts: radiographic evidence of remodeling and hypertrophy.

Abstract: OBJECTIVE.A study was undertaken to determine the growth potential and radio- occurs to a much greater extent in some grafts than in others.

Cited by 38 publications

References 1 publication

Vascularized fibular graft in infected tibial bone loss

Vascularized fibular graft in infected tibial bone loss

Reconstruction of tibia by ipsilateral vascularized fibula and allograft: 12 cases with malignant bone tumors

Iliosacral Resections of Pelvic Malignant Tumors and Reconstruction with Nonvascular Bilateral Fibular Autografts

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