Tibia gap nonunion following sequestrectomy treated with a nonvascularized fibula strut graft

Area of Science:

• Orthopedic Surgery
• Bone Reconstruction
• Pediatric Osteomyelitis

Background:

• Chronic osteomyelitis of the tibia can result in significant bone defects after sequestrectomy.
• Managing these bone gaps presents a considerable challenge for orthopedic surgeons.

Observation:

• A 7-year-old girl presented with a 25 cm tibia defect post-sequestrectomy for chronic osteomyelitis.
• Imaging confirmed healthy tibia segments above and below the defect and an intact fibula.

Findings:

• An ipsilateral subperiosteal nonvascularized fibula was harvested and used as a strut graft to bridge the tibia defect.
• The graft achieved perfect synostosis, the fibula reossified, and bone union occurred in 17 weeks.
• The patient was able to achieve full weight-bearing post-treatment.

Implications:

• Subperiosteal fibula harvest for strut grafting is a viable and effective treatment for large tibial bone defects.
• This surgical approach provides a successful outcome for challenging cases of post-osteomyelitic bone defects.
• This case highlights a practical solution for orthopedic surgeons managing similar complex bone reconstruction scenarios.