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Reconstruction of bone defects after osteomyelitis with nonvascularized fibular graft: a retrospective study in
Sandeep Patwardhan1, Ashok K Shyam, Rustom Adi Mody
1Sancheti Institute for Orthopaedics and Rehabilitation, 16 Shivaji Nagar, Pune 411 005, Maharashtra, India.
Insights
This study shows that nonvascularized fibular grafting effectively treats bone defects in children with osteomyelitis. The procedure, involving staged sequestrectomy, offers a simple solution with a low complication rate for pediatric gap nonunion.
Area of Science:
- Pediatric Orthopedics
- Bone Reconstruction
- Osteomyelitis Treatment
Background:
- Treating pediatric bone defects post-osteomyelitis is challenging due to persistent infection, fibrosis, and periosteal damage.
- A series of 26 children with gap nonunion following osteomyelitis were treated with nonvascularized fibular grafts and intramedullary fixation.
Purpose of the Study:
- To evaluate the efficacy of nonvascularized fibular grafting in treating pediatric bone defects after osteomyelitis.
- To analyze the correlation between bone defect size and time to union.
Main Methods:
- Included 26 children (11 boys, 15 girls; mean age 6.8 years) with post-osteomyelitis gap nonunion.
- Performed debridement, sequestrectomy, followed by nonvascular fibular grafting with intramedullary Kirschner wire fixation once infection was quiescent.
- Correlated bone defect size with time to union.
Main Results:
- Mean follow-up was 3.02 years; mean time to union was 38.76 weeks.
- Weak positive correlation (r=0.699) between bone defect size and time to union.
- Delayed union occurred in 15% of patients, treated with plate fixation; one infection recurrence; limb-length discrepancy managed with shoe lifts.
Conclusions:
- Staged sequestrectomy and nonvascularized fibular grafting is a beneficial treatment for pediatric gap nonunion post-osteomyelitis.
- The procedure is simple, requires no specialized equipment, and has a low complication rate.
Background:
Persistent infection, soft-tissue fibrosis, and damage to periosteum compound the treatment of children with a bone defect following osteomyelitis. We report on a series of twenty-six patients treated with nonvascularized fibular graft and intramedullary fixation.
Methods:
The series included eleven boys and fifteen girls (mean age, 6.8 years; range, three to twelve years) with gap nonunion after osteomyelitis. Initial treatment involved thorough debridement and sequestrectomy. When the infection was quiescent as indicated by inflammatory parameters, nonvascular fibular grafting with intramedullary Kirschner wire fixation (with or without additional external fixation) was performed. The time to union was noted, and a subgroup analysis was performed to correlate the size of the bone defect with the time to union.
Results:
The mean duration of follow-up was 3.02 ± 0.74 years (range, 1.3 to 4.2 years), and the mean time to union was 38.76 ± 12.02 weeks (range, fifteen to sixty weeks). There was a weak positive correlation between the time to union and the preoperative bone defect size (Pearson correlation coefficient, 0.699). The mean time to union was 31.7 ± 11.5 weeks for a defect of <4 cm, 36.6 ± 9 weeks for a defect of 4 to 6 cm, and 51 ± 6.7 weeks for a defect of >6 cm. Delayed union was seen at one end of the fibular graft in four (15%) of the patients and was treated with plate fixation. One patient had recurrence of infection. Limb-length discrepancy (range, 2 to 5 cm) was seen in all patients in whom the lower limb was involved and was treated with a shoe lift.
Conclusions:
This series illustrates the potential benefits of staged sequestrectomy and nonvascular fibular grafting for the treatment of gap nonunion following osteomyelitis in children. The procedure is simple, does not require specialized training or equipment, and has a low complication rate.
