Dual-fibular grafting for massive bone gaps in the lower extremity

Fifty-two patients who had a tumor in the lower extremity (thirty-seven, a giant-cell tumor and fifteen, a small osteosarcoma that had not metastasized) had dual-fibular strut-grafting to bridge the osseous gap resulting from excision of the tumor. The size of the gap ranged from nine to twenty-four centimeters. The average time until union ranged from ten to twenty months. The ipsilateral fibula was used in thirty-six patients and both fibulae, in the remaining sixteen patients. Immediate reimplantation and adequate fixation of the fibular graft to the proximal and distal ends of the bone to be grafted, along with placement of a cuff of cancellous bone at the host-graft junction and between the fibular struts, fostered early union of the graft to the host bone. Insertion of Kirschner wires inside these long grafts helped to maintain continuity of the graft when a stress fracture occurred. Eight patients who had a non-union at one of the host-graft sites and three who had a stress fracture had subsequent cancellous bone-grafting to obtain union. Superficial infection was the most common complication and was seen in seventeen patients.