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

Chronic osteomyelitis of the tibia is a common sequela of acute osteomyelitis which may present with a bone defect following sequestrectomy. Treatment of the gap nonunion can be done with the ipsilateral fibula as a strut graft when harvested subperiosteally and this leads to good outcome. A 7-year-old girl presented to our facility with a 25 cm defect of her right tibia following sequestrectomy for chronic osteomyelitis in another facility. X-rays revealed a healthy tibia superiorly and inferiorly with an intact fibula. She subsequently had an ipsilateral subperiosteal nonvascularized fibula harvest which was used to fill the tibia defect as a strut graft. The synostosis healed perfectly and the fibula reossified, time to union was 17 weeks, and the patient commenced full weight-bearing thereafter. Management of bone gap following sequestrectomy for chronic osteomyelitis remains a challenge to the orthopedic surgeon. The subperiosteal fibular harvest and use as a strut graft is a viable option with good outcomes. Our experience with this case may serve as a way out of this usual challenge.