Modified Capanna’s Technique (Vascularized Free Fibula Combined with Allograft) as a Single-Stage Procedure in Post-traumatic Long-Segment Defects of the Lower End of the Femur: Outcome Analysis of a Series of 19 Patients with an Average Gap of 14 cm

Abstract

Objectives Salvage and reconstruction of posttraumatic defects of the long bone are complex due to the multiple procedures involved and increased chances of poor outcomes. We present the outcomes of the modified Capanna’s technique—a reliable single-stage procedure of combining allograft and free vascularized fibular graft—in treating large posttraumatic bone defects in the distal third of the femur. Study Design This is a retrospective analysis. Materials and Methods Between April 2012 and September 2016, 19 patients with an average age of 33.8 years (range: 18–49 years) and an average defect of 14.5 cm (range: 9.5–20 cm) in the distal femur were managed by the modified Capanna’s technique. Bone union time and functional outcome using lower extremity functional score (LEFS) after union were noted. Outcomes and Results Eighteen grafts went onto achieve bony union at an average of 6.6 months (range: 5–9), with an average knee flexion of 80 degrees (range: 45–110 degrees) and an average LEFS of 63 (range: 46–72). One patient had a nonunion with graft resorption at 8 months following persistent infection and was revised with debridement and augmenting the vascularized fibula from the other leg which went on to achieve union. Three patients had superficial infection, and three patients had delayed union. Conclusion The modified Capanna’s technique provided increased biology and enhanced structural stability and therefore is a good single-stage procedure in the reconstruction of posttraumatic long-segment defects of the distal femur. Level of Evidence Level 4. Level of Clinical Care Level I tertiary trauma center.

Preliminary Results of the “Capasquelet” Technique for Managing Femoral Bone Defects—Combining a Masquelet Induced Membrane and Capanna Vascularized Fibula with an Allograft

“…The mean time to union in the biological reconstruction of extended bone defects varies and depends on the technique used, ranging from four to over twelve months, and full weight-bearing rarely occurs before four to six months [ 12 , 39 , 40 , 41 , 42 ]. With our method, the osteoinductive role played by the induced membrane can exert a positive impact on the bone healing of the graft, with fast allograft and fibula union, early weight-bearing, and a satisfactory functional score.…”

Fibula Musculo-Osteocutaneous Flap with Full Thickness of Flexor Hallucis Longus Muscle

“…Here, vascularised fibula with an allograft has been used. 23 The authors have explained that the allograft would help in providing the strength until the fibula attains the size of the recipient bone. If we do not have an option of using an allograft, use of doble barrel fibula is recommended which would add strength to the reconstructed bone.…”

Periosteal osteosarcoma of the femur treated with modified capanna procedure: A case report

“…Nonetheless, when a double-barrel graft is utilised, the length of the defect that can be reconstructed becomes significantly lower. So, it would be a major challenge to reconstruct defects of more than 12 cm [13] , [14] , [15] , [16] .…”

“…Jayaramaraju D et al had reported the result of modified capanna's technique using vascularized free fibular graft combined with allograft for post-traumatic long-segment defects of the lower end of the femur [13] . They reported that the bony union was achieved at mean of 6.6 months (range: 5-9).…”

“…They reported that the bony union was achieved at mean of 6.6 months (range: 5-9). The mean of knee flexion was 90 degrees (range:45–110 degrees) and the mean of lower extremity functional score (LEFS) was 63 (range 46-72) [13] . Venkatramani H et al also reported that the procedure of modified Capanna's technique resulted in graft union with average time of 6 months [15] .…”