[The non-vascularised fibular transfer - indications and limits in infancy and adulthood]

The non-vascularised fibular transfer is an established surgical procedure whose indication limits are verified and discussed.

12 patients with an average age of 17.9 years have been treated with a non-vascularised fibula transfer. The results are evaluated critically in comparison with those in the relevant literature.

In ten cases a bone tumour and in two cases a chronic osteomyelitis have been treated. 11/12 patients showed a complete osseous integration. In one case a rigid pseudarthrosis of the ankle joint was observed. Clinical results were evaluated by the MSTS score (results 83.3-100).

The non-vascularised fibula transfer is a reliable method to span bony defects of up to 25 cm in length. Unlike the autologous spongiosa graft it ensures a mechanical support because of the high cortical proportion. A temporarily occurring absorption of the transplant can be solved by a vascularised transfer, also the indication can be extended for covering combined osseous-soft tissue-defects or for reconstruction of the growth plate through epiphyseal transplantation. Indeed a strikingly increased extraction morbidity by resection of the peroneal artery and an essential elevated surgical effort are associated with these procedures. In consideration of the excellent results, the indication limits of the non-vascularised fibula transfer need to be defined. It can be successfully applied, especially in infancy, under the following conditions: unstable osseous defects with vital soft tissues, appropriate shape of the fibula for reconstruction as well as appropriate osseous requirements for a stable incorporation or osteosynthesis.