Enhanced Viability and Clinical Outcomes of Non-vascularized Fibular Strut Grafts: a 50-Year Experience of 621 Cases.

Aims: Non-vascularised fibular grafts have been used for over a century as means of reconstruction the skeletal defects. The aim of this study was to evaluate the viability and clinical outcomes of non-vascularized fibular strut grafts using an immediate fixation technique. This enables them to retain their viability for early incorporation with the host-bone.

Materials and methods: During the last 5 decades, 621 cases of bone gaps have been managed with non-vascularised fibular struts in various clinical situations. Out of these 498 cases were after excision of bone tumours, 90 post-infective gaps and 33 post-traumatic. According to the site of the defect, single fibular struts were used in 115 cases, twin grafts in 493 and triple struts in 13 cases. The size of the graft measured from 5 to 25 cms.

Results: Functional results have been evaluated according to the Clinical and Radiological score. The biological activity resulting in union and hypertrophy of the twin and triple struts demonstrated the viability of the grafts in 91% cases. Evidence of radiological non-union at one of the host-graft junctions resulted in 39 cases. Stress fractures had been observed in 22 cases only in single grafts and none in twin or triple grafts.

Conclusion: The technique of immediate fixation of non-vascularized fibular grafts at the host site appears to have changed the age-old concept regarding the non-vascularised grafts. The results have revealed that such struts retain their osteogenic cells and remain viable resulting in 'lateral-union' and unite with the host bone without undergoing the classical degenerative changes.

Level of evidence: IV.