Osteosynthesis of Postosteomyelitic Forearm Defects in Children Using a Modified Bone Grafting Technique: The Fibular Intramedullary Bridging Bone and Additional Grafting (FIBBAG)

Abstract

Background: There are many options to treat post osteomyelitic gaps in forearm bones. We report a pediatric series with postosteomyelitic forearm segmental defects reconstructed with fibular only graft: the non vascular fibular intramedullary bridging bone and additional grafting (FIBBAG) and the results thereof. Methods: Outcomes in 8 patients treated with fibular strut and overlay matchstick grafts were retrospectively assessed. The clinical results were expressed as forearm shortening, range of motion at elbow and wrist joint. The radiological evaluation included time to union, presence of fractures and recurrence of infection, if any. Results: The average patient age was 6 years (range, 3–12 years). The radius was involved in 6 and ulna in 2. Union occurred in all patients. The average intraoperative gap to be spanned was 5.86 cm (range, 3–14 cm). The average time for union was 6.63 months (range, 2–14 months). Two patients required additional bone grafting procedures. No graft fatigues/fractures were noted in available follow up. There was no recurrence of infection in any case. A positive ulnar variance was seen in 3 patients at follow up. Forearm shortening was a major cosmetic limitation following the procedure. Conclusions: Fibular strut and additional bone grafting (FIBBAG) is one of the viable options for reconstruction of post osteomyelitic forearm defects in children with low procedural complication rate.

Treatment of Recalcitrant Nonunion of the Radius With Posterior Interosseous Bone Flap in Children

“…According to the 2 systematic reviews by Siebelt et al5 and Solla et al,22 VFBG has the best clinical outcome in congenital forearm pseudoarthrosis. This shift toward vascularized grafting techniques in treating segmental gaps in long bones has also emerged in other situations, such as nonunions of infantile osteomyelitis in the forearm, another rare condition present in our second patient 25,26. Nonunion in OI is not uncommon.…”

“…This shift toward vascularized grafting techniques in treating segmental gaps in long bones has also emerged in other situations, such as nonunions of infantile osteomyelitis in the forearm, another rare condition present in our second patient. 25,26 Nonunion in OI is not uncommon. The treatment of this nonunion is sometimes challenging, mostly when the nonunion has occurred spontaneously.…”

Emerged donor limb growth morbidity and malalignment after combined ipsilateral tibial and fibular cortical harvest graft in children. Early follow-up report

“…The combined tibial and fibular harvesting as described in our series, although being a known procedure, has scantly been elucidated in literature [5–7]. Our series on such 16 dual harvests showed that tibial healing proceeded unhindered being an incomplete window-type resection (Fig.…”

“…The combined harvests, however, sum up as a major surgical procedure and require postoperative immobilization in a cast [5]. Postprocedure, the clinician’s focus is largely restricted to primary site outcome [6,7]. The overall impact of harvests on donor legs largely remains undocumented and therefore, formed the basis of the present research.…”

“…When the harvest is obtained with a nonvascularized technique, regeneration of both bones is theoretically possible as the periosteum is preserved. As such, the procedure is commonly perceived to be overall well-tolerated and donor sites are seldom investigated at follow-up [6,7]. Lately, several studies have reported donor site complications both in the short-and long-term after nonvascularized fibular grafts in children [8][9][10][11][12].…”