A Case Series: Non-vascularized Autologous Fibular Graft in the Treatment of Major Segmental Bone Defect after Post-traumatic at Diaphyseal Femur

Authors

  • Hidayat Siregar Department of Orthopaedics and Traumatology, Lower Division, Faculty of Medicine, University of Sumatera Utara, Haji Adam Malik General Hospital, Medan, Indonesia https://orcid.org/0000-0003-2592-3445
  • Rahmad Gunawan Department of Orthopaedics and Traumatology, Faculty of Medicine, University of Sumatera Utara, Haji Adam Malik General Hospital, Medan, Indonesia
  • Didi Fitriadi Department of Orthopaedics and Traumatology, Faculty of Medicine, University of Sumatera Utara, Haji Adam Malik General Hospital, Medan, Indonesia https://orcid.org/0000-0001-8190-878X

DOI:

https://doi.org/10.3889/oamjms.2021.6723

Keywords:

Major bone defect, Non-vascularized autologous fibular graft, Autologous bone grafts, Femoral shaft fracture, Open fracture, Musculoskeletal reconstruction, Bone loss, Nonunion

Abstract

BACKGROUND

In the management of bony defects, autologous bone grafts can be used as the mechanical structure for reconstruction to restore aesthetics and function, Non-vascularized autologus fibular graft are often used to the treat large post traumatic defects caused by high-energy trauma with open fracture and nonunion cases for 1st and 2nd cases. Here we would like to present a 16-year-old woman and a 37-year-old man patients of major bone defect at the right femoral shaft region using 9 cm and 10 cm non-vascularized fibular autogenous grafts.

 

OBJECTIVE

The purpose of this case report was to determine the effectiveness of non-vascularized autologus fibular graft for major bone defect at the regio femoral shaft for the reconstruction of post traumatic case.

 

MATERIAL AND METHODS

We treat post traumatic of the major bone defect at the regio femoral shaft with 9 cm and 10 cm femoral non-vascularized autologus fibular graft and fixed by a limited contact dynamic compression plate and femoral locking plate methode by routine phisioteraphy.

 

RESULTS

The Patient have a good result with good functional outcome after open reduction internal fixation (ORIF) and using a non-vascularized autologus fibular graft for treating the major bone defect after post traumatic femoral shaft fracture.

 

CONCLUSION

Complete and comperhensive open reduction internal fixation (ORIF) with autologous non- vascularized fibular graft, stabilized fracture by limited contact dynamic compression plate for 1st patient and femoral locking plate for 2nd patient allowing with an early rehabilitation is an acceptable, Phisioteraphy and early mobilisation resulting better outcome for the patient, all of this are less expensive, can be accepted at the hospitals that limited facilities and health professionals for professional subspeciality and widely reproducible option to manage bone defects in open shaft femoral fractures to achieving union, preserving length and motion with no donor site morbidity, giving patients good functional outcome and radiologic result.

  KEYWORDS

Major bone defect, non-vascularized autologus fibular graft, autologous bone grafts, femoral shaft fracture, Open Fracture, Muskuloskeletal Reconstruction, Bone Loss, Nonunion.

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References

Lawal YZ, Garba ES, Ogirima MO. Use of non-vascularized autologous fibula strut graft in the treatment of segmental bone loss. Ann Afr Med. 2011;10(1):25-8. https://doi.org/10.4103/1596-3519.76571 PMid:21311151

El-Sayed M, El-Hadidi M, El-Adl W. Free nonvascularized fibular graft for treatment of post-traumatic bone defects. Acta Orthop Belg. 2007;73(1):70-6. PMid:17441661

Masquelet AC, Begue T. The concept of induced membrane for reconstruction of long bone defects. Orthop Clin North Am. 2010;41(1):27-37. https://doi.org/10.1016/j.ocl.2009.07.011 PMid:19931050

Masquelet AC, Fitoussi F, Begue T, Muller GP. Reconstruction of the long bones by the induced membrane and spongy auto-graft. Ann Chir Plast Esthet. 2000;45(3):346-53. PMid:10929461

Masquelet AC. Muscle reconstruction in reconstructive surgery: Soft tissue repair and long bone reconstruction. Langenbecks Arch Surg. 2003;388(5):344-6. https://doi.org/10.1007/s00423-003-0379-1 PMid:13680234

Thakkar CV, Dwivedi MS. Open distal femur fractures: Treatment principles. Int J Orthop Sci. 2018;4(4):732-6. https://doi.org/10.22271/ortho.2018.v4.i4i.89

Dinh P, Hutchinson BK, Zalavras C, Stevanovic MV. Reconstruction of osteomyelitis defects. Semin Plast Surg. 2009;23(2):108-18. PMid:20567733

Yajima H, Tamai S, Mizumoto S, Inada Y. Vascularized fibular grafts in the treatment of osteomyelitis and infected nonunion. Clin Orthop Relat Res. 1993;293:256-64. https://doi.org/10.1097/00003086-199308000-00033 PMid:8339489

Sun Y, Zhang C, corresponding author Dongxu Jin, Jiagen Sheng, Xiangguo Cheng, Xudong Liu, Shengbao Chen, and Bingfang Zeng. Free vascularised fibular grafting in the treatment of large skeletal defects due to osteomyelitis. Int Orthop. 2010;34(3):425-30. https://doi.org/10.1007/s00264-009-0761-x PMid:19308407

Lenze U, Kasal S, Hefti F, Krieg AH. Non-vascularized fibula grafts for reconstruction of segmental and hemicortical bone defects following meta-/diaphyseal tumour resection at the extremities. BMC Musculoskelet Disord. 2017;18(1):289. https://doi.org/10.1186/s12891-017-1640-z PMid:28679368

Xiong R, Mai QG, Yang CL, Ye SX, Zhang X, Fan SC et al. Intramedullary nailing for femoral shaft fractures in adults. Cochrane Database Syst Rev. 2013;5:1-4. https://doi.org/10.1002/14651858.cd010524

Weiland AJ, Moore JR, Daniel RK. Vascularized bone autografts. Experience with 41 cases. Clin Orthop Relat Res. 1983;174:87-95. https://doi.org/10.1097/00003086-198304000-00010 PMid:6339145

Gazdag AR, Lane JM, Glaser D, Forster RA. Alternatives to autogenous bone graft: Efficacy and indications. J Am Acad Orthop Surg. 1995;3(1):1-8. PMid:10790647

Dell PC, Burchardt H, Glowczewskie FP Jr. A roentgenographic, biomechanical, and histological evaluation of vascularized and non-vascularized segmental fibular canine auto-grafts. J Bone Joint Surg Am. 1985;67(1):105-12. https://doi.org/10.2106/00004623-198567010-00013 PMid:3881445

Doi K, Tominaga S, Shibata T. Bone grafts with microvascular anastomosis of vascular pedicles: An experimental study in dogs. J Bone Joint Surg Am. 1977;59(6):806-15. https://doi.org/10.2106/00004623-197759060-00015 PMid:908705

Shah KB, Kamath J, Jayasheelan N, Danda R, Rai MK. Non-vascularized fibular strut grafting in management of bone defects. Online J Health Allied Scs. 2015;14(4):14.

Azam MQ, Iraqi AA, Sherwani M, Sabir AB, Abbas M, Asif N. Free fibular strut graft in neglected femoral neck fractures in adult. Indian J Orthop. 2009;43(1):62-6. https://doi.org/10.4103/0019-5413.45325 PMid:19753182

Elgeidi A, El-Negery A. Fibular graft for non-united femoral neck fractures in children. J Child Orthop. 2017;11(1):28-35. https://doi.org/10.1302/1863-2548-11-160221 PMid:28439306

Tall M, Bonkoungou D, Sawadogo M. Treatment of nonunion in neglected long bone shaft fractures by osteoperiosteal decortication Orthop Traumatol Surg Res. 2014;100 Suppl 6:S299-303. https://doi.org/10.1016/j.otsr.2014.07.005 PMid:25193620

Zhang Q, Zhang W, Zhang Z, Zhang L, Chen H, Hao M, et al. Femoral nonunion with segmental bone defect treated by distraction osteogenesis with monolateral external fixation. J Orthop Surg Res. 2017;12(1):183. https://doi.org/10.1186/s13018-017-0684-y PMid:29178906

Paterno MV, Archdeacon MT, Ford KR, Galvin D, Hewett TE. Early rehabilitation following surgical fixation of a femoral shaft fracture. Phys Ther. 2006;86(4):558-72. https://doi.org/10.1093/ptj/86.4.558 PMid:16579672

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Published

2021-09-10

How to Cite

1.
Siregar H, Gunawan R, Fitriadi D. A Case Series: Non-vascularized Autologous Fibular Graft in the Treatment of Major Segmental Bone Defect after Post-traumatic at Diaphyseal Femur. Open Access Maced J Med Sci [Internet]. 2021 Sep. 10 [cited 2021 Nov. 30];9(C):175-81. Available from: https://oamjms.eu/index.php/mjms/article/view/6723

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Case Report in Surgery

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