Non-Vascularised Fibular Grafting After Resection of Distal Femoral Tumours: An Initial Observation.

Abstract

Background: Vascularized fibular grafting, allografting, megaprosthesis and allograft-prosthesis composite are suitable limb salvage techniques after resection of the whole of distal femur but are not easily available in underdeveloped countries. This difficulty prompted the use of non-vascularized fibular grafting in bridging wide distal femoral defects that have resulted from excision of tumours.

Objective: To study the incorporation of long non- vascularized fibular autografts in arthrodesis of the knee as a limb salvage technique in a developing country.

Method: Non-vascularized fibular grafts were used in spanning wide bone defects that had resulted from excision of distal femoral tumours in two patients. One of the defects was 10cm and the other was 15cm. long. A customized external fixator was used for initial immobilization of the limbs after surgery. Later the limbs were immobilized with re-enforced plaster-of-Paris cast.

Result: The grafts showed a peculiar mode of avascular necrosis. In one patient 2cm and in the other patient 3cm of one of the ends of graft was not incorporated.

Conclusion: Although the two patients were lost to follow-up, the initial observation showed such a wide non-vascularized fibular grafting for arthrodesis of the knee after resection of the distal femoral tumours is a feasible limb salvage technique in resource poor countries.


Keywords: limb salvage; non-vascularized fibular graft

Nigerian Journal of Orthopaedics and Trauma Vol. 6 (2) 2007: pp. 83-85