Lengthening After Nonvascularized Fibula Grafting for Large Postinfective Bone Defect: A Case Report with Long...

Area of Science:

• Pediatric Orthopedics
• Regenerative Medicine
• Limb Reconstruction Surgery

Background:

• Postinfective tibial gap nonunion presents a significant challenge in pediatric limb reconstruction.
• Nonvascularized fibula grafting is a common method for addressing large bone defects.
• Distal tibial physeal arrest can lead to limb length discrepancies.

Observation:

• A 10-month-old boy with a large tibial defect due to osteomyelitis underwent fibula autografting.
• The patient experienced distal tibial physeal arrest, resulting in progressive limb shortening.
• Two sessions of distraction osteogenesis were performed on the grafted segment.

Findings:

• The tibial regenerate demonstrated successful lengthening through distraction osteogenesis.
• A total lengthening of 9 cm was achieved over two distraction osteogenesis procedures.
• The patient showed good functional recovery by 11.5 years of age.

Implications:

• This case highlights the potential of distraction osteogenesis in lengthening the tibial regenerate in pediatric patients.
• Nonvascularized fibula grafts can serve as a viable substrate for subsequent limb lengthening.
• Successful limb lengthening can lead to improved function and quality of life in children with bone defects.