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Vascularized Fibula Grafting for the Treatment of Bone Defects
Jacob Didesch, MD; Virak Tan, MD
Rutgers University-New Jersey Medical School, Newark, NJ

Introduction: Vascularized fibula grafting has been used in the treatment of large skeletal defects as well as recalcitrant atrophic nonunions and infected nonunions. Few studies have examined the factors contributing to nonunion of the fibula graft at one or both graft-recipient junctions, and specifically at the relationship of graft length to rate of union. The purpose of the current study was to determine if a correlation exists between length of the vascularized fibula graft and primary union of the graft-recipient interface at the proximal and/or distal junction.
Methods: 21 patients who underwent vascularized fibula grafting from 2002-2014 for the treatment of skeletal defects were included. Radiographs were assessed for union of the graft at the proximal and distal junctions. The rates of union at the proximal and distal junctions were determined with respect to the limb and graft orientation. The relationship between the length of graft utilized and union was assessed using Pearson Correlation.
Results: 71.4% of patients, with an average follow up of 30.2 months, achieved complete union at an average of 8.7 months. With respect to the limb, a union rate of 95.2% (20/21) was achieved at the distal graft-recipient junction compared to 71.4% (15/21) at the proximal junction (p=0.038). With respect to the graft orientation, a union rate of 90.5% (19/21) was achieved at the distal graft compared to 76.2% (16/21) at the proximal graft (p=0.214). The length of the graft did not have a significant correlation to the rate of union. Discussion and
Conclusion: The length of the fibula graft does not appear to have an association with the rate of primary union. Union reliably occurs at least at one end of the graft and complete nonunion of the graft is rare. However, if primary union is not achieved, likely nonunion will have occurred at the proximal graft-recipient junction.

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