Treatment of Large Bone Defect of Long Bones: Comparison of Free Vascularized Fibular Graft with Compression-Distraction Technique

Abstract

We treated 18 patients with congenital pseudarthrosis of tibia and 27 patients with acquired bone loss. Out of 18 cases of congenital pseudarthrosis of tibia the free vascularized fibular grafts (FVFGs) were performed in 16 cases and compression-distraction techniques in 2 cases. In patients with angular deformities and shortenings in the lower leg soft tissue distraction and correction were conducted. The mean soft tissue distraction period was 78.4 days, the length of bone defect 10.7 cm, the mean operative time 3.2 hours, and primary bone healing achieved in 12 cases. The mean union period was 7.3 months and the mean period of full weight bearing was 10.8 months. In 4 cases pseudarthroses and deformities developed and healed secondarily, and the treatment period ranged from 16 months to 26 months. The mean length of bone defects was 9.7 cm and the mean period of full weight bearing 14 months. The mean length of bone defects in the group of Ilizarov technique was 6.6 cm, the mean period of distraction 82 days and the mean period of full weight bearing 12.2 months. The complications include pseudarthrosis, refracture, angular deformity, equinovarus and temporary peroneal nerve palsy in the FVFG group and in the group of compression-distraction technique, refracture, equinovarus and temporary peroneal nerve palsy. The FVFG is suitable for the treatment of pseudarthrosis in young patients and the compression-distraction technique is effective option for the treatment of bone defects of patients with infection and deformity.