Distraction Osteogensis of Free Vascularised Fibular Grafts in Long Bones: A Case Series

Description

In this presentation, limb reconstruction surgeon Ross Muir discusses various techniques for treating large intercalary bone defects, highlighting the use of free vascularized fibula grafts due to their quicker time to union compared to other methods. However, he notes the limitations of donor fibula length and diameter, which can lead to limb length discrepancy and possible complications, including fracture or deformation in the weight-bearing limb. The presentation outlines the Ilizarov principles of distraction osteogenesis as a valuable alternative for managing these issues, particularly in cases where sufficient normal bone exists proximal and distal to the graft.



The discussion delves into case studies of four patients who underwent correction for symptomatic deformities resulting from previous stress fractures in fibular grafts. Two patients, treated in childhood for congenital pseudoarthrosis of the tibia, later presented with malunions and length deficits in their late teens. The other two patients experienced sclerosing osteomyelitis as adults, treated through segmental excision and grafting.



Muir details the surgical approach for deformity correction utilizing a four Ilizarov frame, noting that careful attention was paid to preserving blood supply during osteotomies. He reports successful progression to union with a notable lengthening achieved and highlights some complications, including persistent pain and recurrence of deformities, emphasizing the importance of careful monitoring post-treatment due to potential issues such as stress fractures in the graft.



Concluding, Muir affirms that distraction osteogenesis through free vascularized fibular grafts is technically viable and effective but requires meticulous technique to mitigate risks such as thermal necrosis during wire insertion. He advises that patients be informed of the ongoing risk of stress fractures even after deformity corrections.

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