Reconstruction of Large Skeletal Defects Due to Osteomyelitis with the Vascularized Fibular Graft in Children

Zalavras, Charalampos G.; Femino, Dominic; Triche, Rachel; Zionts, Lewis; Stevanovic, Milan
October 2007
Journal of Bone & Joint Surgery, American Volume;Oct2007, Vol. 89-A Issue 10, p2233
Academic Journal
Background: Reconstruction of large skeletal defects secondary to osteomyelitis is a challenging problem. The purpose of this study was to evaluate the outcome of the use of a vascularized fibular graft to treat such defects in children. Methods: Eight patients with a mean age of seven years and a skeletal defect with a mean length of 11.8 cm (range, 6 to 17 cm) were treated with a vascularized fibular graft. A staged protocol was used for the five patients with an active infection at the time of presentation. The first procedure consisted of radical débridement, and at the second stage a free (seven patients) or pedicled (one patient) vascularized fibular graft was used. The mean follow-up time was 5.7 years. Results: Union of the graft occurred primarily in seven of the eight patients, at a mean of 3.5 months, and after iliac crest bone-grafting in the remaining patient. There was no recurrence of deep infection. Complications developed in two patients. The mean time to full weight-bearing by the seven patients with a lower-extremity reconstruction was 8.4 months, and all patients were pain-free and able to walk without supportive devices. Conclusions: A vascularized fibular graft is a viable option for the management of large skeletal defects resulting from osteomyelitis in children. Level of Evidence: Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence.


Related Articles

  • A Prospective Multicenter Randomized Clinical Trial of Autogenous Bone Versus β-Tricalcium Phosphate Graft Alone for Bilateral Sinus Elevation: Histologic and Histomorphometric Evaluation. Szabó, György; Huys, Luc; Coulthard, Paul; Malorana, Carlo; Garagiola, Umberto; Barabás, József; Németh, Zsolt; Hrabák, Károly; Suba, Zsuzsanna // International Journal of Oral & Maxillofacial Implants;May/Jun2005, Vol. 20 Issue 3, p371 

    Purpose: Two different graft materials, β-tricalcium phosphate (Cerasorb) and autogenous bone, were used in the same patient. The objective was to determine whether donor site morbidity could be avoided by using pure-phase β-tricalcium phosphate (Cerasorb). Materials and Methods: Bilateral...

  • Treatment of Segmental Loss of the Tibia by Tibialisation of the Fibula: A Review of the Literature. Rahimnia, Alireza; Fitoussi, Frank; Penneçot, George; Mazda, Keywan // Kowsar Medical Journal;Winter2012, Vol. 16 Issue 4, p154 

    Segmental defects of the tibia are challenging therapeutic problems for both the physician and the patient. These defects may be caused by severe trauma, infection, tumors and congenital processes. Several different techniques have been described for treatment of these defects including the...

  • The manufacture of synthetic non-sintered and degradable bone grafting substitutes. Gerike, W.; Bienengräber, V.; Henkel, K.-O.; Bayerlein, T.; Proff, P.; Gedrange, T.; Gerber, Th. // Folia Morphologica;2006, Vol. 65 Issue 1, p54 

    A new synthetic bone grafting substitute (NanoBone®, ARTOSS GmbH, Germany) is presented. This is produced by a new technique, the sol-gel-method. This bone grafting substitute consists of nanocrystalline hydroxyapatite (HA) and nanostructured silica (SiO2). By achieving a highly porous...

  • Bone functions and the requirements for bone grafts and substitutes in the orofacial region. Fanghänel, J.; Bayerlein, T.; Gedrange, T.; Kauschke, E.; Rumpel, E.; Gerike, W.; Bienengräber, V.; Proff, P. // Folia Morphologica;2006, Vol. 65 Issue 1, p56 

    Bone is the largest calcium storage, has distinctive plasticity and adaptability and is part of the supporting tissue. An adequate composition is thus necessary. The bone matrix consists of organic and anorganic structures. Osteoblasts, osteoclasts and osteocytes are responsible for bone...

  • Critical considerations on the diagnostic appraisal, adaptation and remodelling of bone graft substitutes. Gedrange, T.; Bayerlein, T.; Fanghänel, J.; Landsberger, P.; Hoffmann, A.; Kauschke, E.; Rumpel, E.; Gerike, W.; Bienengräber, V.; Proff, P. // Folia Morphologica;2006, Vol. 65 Issue 1, p59 

    The diagnostic assessment of skeletal defects has a long-standing tradition. As a result of the development of new bone grafting materials, the demands on diagnostic assessment have also increased. The mode and quality of diagnostic appraisal are crucial to further clinical use and outcome...

  • The clinical application of a new synthetic bone grafting material in oral and maxillofacial surgery. Bienengräber, V.; Gerber, Th.; Henkel, K.-O.; Bayerlein, T.; Proff, P.; Gedrange, T. // Folia Morphologica;2006, Vol. 65 Issue 1, p84 

    A novel bone formation material based on hydroxyapatite-xerogel is presented. With the use of the innovative sol-gel technology this material is produced in the low-temperature range by the addition of silicon dioxide; in its structure it mimics to a great extent the natural bone matrix. This...

  • Use of non-vascularized autologous fibula strut graft in the treatment of segmental bone loss. Lawal, Y. Z.; Garba, E. S.; Ogirima, M. O.; Dahiru, I. L.; Maitama, M. I.; Abubakar, K.; Ejagwulu, F. S. // Annals of African Medicine;2011, Vol. 10 Issue 1, p25 

    Background: Fractures resulting in segmental bone loss challenge the orthopedic surgeon. Orthopedic surgeons in developed countries have the option of choosing vascularized bone transfers, bone transport, allogenic bone grafts, bone graft substitutes and several other means to treat such...

  • Cone prosthesis for the hip joint. Wagner, Heinz; Wagner, Michael // Archives of Orthopaedic & Trauma Surgery;Jan2000, Vol. 120 Issue 1/2, p88 

    The shape of the proximal segment of the femur must be taken into account when implanting femoral endoprostheses, especially those intended for cementless anchorage. Numerous femoral prostheses are available for the proximally broadly extending, “trumpet-shaped” morphology. However,...

  • Remodeling of cortical bone allografts mediated by adherent rAAV-RANKL and VEGF gene therapy. Ito, Hiromu; Koefoed, Mette; Tiyapatanaputi, Prarop; Gromov, Kirill; Goater, J. Jeffrey; Carmouche, Jonathan; Xinping Zhang; Rubery, Paul T.; Rabinowitz, Joseph; Samulski, R. Jude; Nakamura, Takashi; Soballe, Kjeld; O'Keefe, Regis J.; Boyce, Brendan F.; Schwarz, Edward M. // Nature Medicine;Mar2005, Vol. 11 Issue 3, p291 

    Structural allograft healing is limited because of a lack of vascularization and remodeling. To study this we developed a mouse model that recapitulates the clinical aspects of live autograft and processed allograft healing. Gene expression analyses showed that there is a substantial decrease in...


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics