Free vascularized fibular graft vs. Ilizarov method for post-traumatic tibial bone defect

From 1991 to 1996, four free vascularized fibular grafts (FVFG) and four callus distraction (CD) techniques were performed for post-traumatic tibial defects at the authors' institute. They attempted to discern any differences of results between FVFGs and CDs for post-traumatic tibial defects. The mean defect length of the FVFG and CD groups were 7.3 cm and 4.6 cm, respectively (p < 0.05). They selected as contributing factors: external fixation time, complication rate, hospital charge, union rate, and functional score (Puno's criteria), in order to compare the treatment of FVFG with that of CD. The external fixation times of the FVFG and CD groups were 176 days and 261 days, respectively. One septic non-union after refracture of the grafted fibula occurred in the FVFG group. Two non-unions (50 percent) at the docking site occurred in the CD group. The mean total costs of the FVFG and CD groups were 7,398,536 yen (US $68,505) and 11,798,153 yen(US $109,242), respectively. The union rates of both groups were 75 percent and 100 percent, respectively. The mean functional scores of both groups were 69.5 and 88.8 points, respectively. The functional results of the FVFG group were as follows: one patient showed good results; one, fair; and two, poor. The functional results of the CD group were as follows: two patients showed excellent results; one, good; and one, fair. Both the costs and the functional outcomes between the two groups did not significantly differ. No clear differences between the two treatment groups could be determined. However, many more cases are needed to establish statistically significant differences between both methods.