• Yih-Wen Tarng and Ki-Chen Lin.
• Department of Orthopaedics, Kaohsiung Veterans General Hospital, Kaohsiung city, Taiwan; Department of Orthopaedics, National Defense Medical Center, Taipei city, Taiwan; Department of Physical Therapy, Shu Zen College of Medicine and Management, Taiwan. Electronic address: yihwentarng332@yeahmca.com.
• Injury. 2020 Feb 1; 51 (2): 294-300.

ObjectivesBone defects as a result of infected non-union or chronic osteomyelitis are difficult to manage. The purpose of this study was to present the results of treatment of bone defects of < 6 cm due to a previous infected non-union or chronic osteomyelitis with autologous non-vascularized fibular grafts in a 2-stage surgery.Patients And MethodsThe records of patients who were treated with autologous non-vascularized fibular grafts for bone defects of < 6 cm due to a previous infected non-union or chronic osteomyelitis between 2008 and 2013 were retrospectively reviewed. Primary complete bone union was the primary outcome. Time until fracture union, and return to normal daily activities or previous work were recorded. Radiographs were evaluated for graft hypertrophy as well as for stress fracture and other complications.ResultsA total of 27 cases were included. The mean length of the bone defects was 4.4 cm (range 2 - 6 cm). Complete union and healing occurred in 25/27 patients (primary success rate of 92.6%). Non-union was present in two patients with suboptimal soft tissue condition 10 months after surgery, one patient was subsequently treated with a vascularized free fibular graft from the contralateral fibula, and the other patient was treated with distraction osteogenesis, bone union was achieved after the second surgery. Average time to return to normal daily activity after surgery was 7.82 months (6 ~ 11 months). Graft hypertrophy occurred in 15 cases 15/25 (60%) two years post-surgery. There were no other surgical or postoperative complications.ConclusionsWith careful evaluation of soft-tissue condition surrounding bone defect, management of infected bone defects with autologous non-vascularized fibular grafts technique has a high success rate with few complications.Copyright © 2019. Published by Elsevier Ltd.

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