Vascularized fibular grafting for reconstruction of bone defect of the radius

BackgroundThe vascularized bone graft is indicated in patients where conventional bone grafting has failed or long bone defects, exceeding 6 cm, are observed in the radius. Fibular grafts allow the use of a segment of diaphyseal bone that is structurally similar to the radius and of sufficient length to reconstruct most defects of the radius.Patients and methodsBetween 2005 and 2008, seven patients with segmental bone defects of the radius were managed with vascularized fibular grafts: six females and one male, aged 12 years on average (range, 3-21 years). The length of bone defect was 7.5 cm on average (range, 4-13 cm). In six cases, the fibular graft was harvested as a vascularized osseous flap and in one case, as an osteoseptocutaneous flap. To achieve fixation of the grafted fibula, intramedullary Kirschner wires were used in six cases and plate in one case. The follow-up period ranged from 4 to 39 months.ResultsAll flaps were successful. Four patients required secondary procedures in the form of revision of internal fixation, iliac bone grafting, and ulnar shorting. The mean period to radiographic bone union was 4.8 months (range, 2.5-8 months).ConclusionVascularized fibular graft is a reliable technique for reconstruction of bone defects of the radius even in the presence of infection.Level of evidenceLevel IV, therapeutic case series.