Non-vascularised fibular transfer in the management of defects of long bones after sequestrectomy in children

• Published in: Journal of bone and joint surgery. British volume Vol. 87; no. 9; pp. 1259 - 1263
• Main Authors: STEINLECHNER, C. W. B, MKANDAWIRE, N. C
• Format: Journal Article
• Language: English
• Published: London British Editorial Society of Bone and Joint Surgery 01.09.2005; British Editorial Society of Bone & Joint Surgery
• Edition: British volume
• Subjects: Adolescent; Bacterial arthritis and osteitis; Bacterial diseases; Biological and medical sciences; Bone Transplantation - methods; Child; Child, Preschool; Chronic Disease; Debridement; Female; Fibula - transplantation; Graft Survival; Human bacterial diseases; Humans; Infectious diseases; Male; Medical sciences; Orthopedic surgery; Osseointegration; Osteomyelitis - diagnostic imaging; Osteomyelitis - surgery; Osteotomy; Radiography; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Tibia - diagnostic imaging; Tibia - surgery; Treatment Outcome; Human; Pseudoarthrosis; Radius; Fibula; Excision; Diseases of the osteoarticular system; Cardiovascular disease; Thrombosis; Necrosis; Vascular disease; Infection; Chronic; Orthopedic surgery; Clinical management; Treatment; Tibia; Debridment; Limb; Osteitis; Bone defect; Humerus; Child; Long bone
• ISSN: 0301-620X; 2049-4394; 2044-5377; 2049-4408
• DOI: 10.1302/0301-620X.87B9.15734

The management of chronic osteomyelitis requires the excision of necrotic and infected material followed by the prolonged administration of antibiotics. Sequestrectomy may be required before an involucrum has formed, resulting in a longitudinal bone defect. This can be difficult to fill. Vascularised grafts are complicated by a high rate of recurrent infection and thrombosis. We have managed defects of long bones in children after sequestrectomy by the use of non-vascularised fibular grafts harvested subperiosteally and held by an intramedullary Kirschner wire. Eight children underwent this procedure. In six the tibia was involved and in one each the humerus and radius. One patient was lost to follow-up. Six grafts united at both ends within 12 weeks. The seventh developed an infected nonunion distally which united after further debridement. One patient required a further sequestrectomy which did not compromise union. We have found this to be a straightforward technique with reliable results and were able to salvage the limb in all the seven patients who were reviewed.