Non-vascularized fibular strut grafting in management of bone defects

Background: Frequently in orthopedic practice, we come across massive bone defects, which can result from open fractures, gap non-unions and following resection of bone tumours. The problems involved in bridging or regenerating areas of skeletal loss with viable bone while maintaining limb length and alignment, along with satisfactory function remains a substantial challenge. The present study was carried out for evaluation & analysis of the role of non-vascularised fibular grafting in managing such bone defects. Methods: 25 cases with bone gap were treated with non-vascularized fibular strut graft from June 2010 to Sept 2012. There were 13 cases of gap non-union, 9 cases of tumour resection and 3 cases of post traumatic bone loss. Functional outcome was assessed by MSTS Score. Results: A total of 71 graft host junctions were studied, out of which 68 united, in a mean period of 13 weeks. Functional outcome was good with a mean MSTS Score of 76.63%. Average size of bone gap treated was 5.19 cm. Primary cancellous grafting was done in 15 cases. Size of bone gap or use of primary cancellous bone graft had no statistically significant relationship with time taken for union. Conclusion: Non-Vascularized fibular strut grafting is a simple, inexpensive and an effective technique in bridging bone gaps. It takes longer duration to achieve union, but if used in selected patients with good vascular bed and soft tissue coverage, can yield comparable results to vascularized fibular grafts in terms of overall union.