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Related Concept Videos

Fractures: Bone Repair01:27

Fractures: Bone Repair

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Treatment for a fracture is based on the type of break, the bone affected, and the patient's age.
Minor fractures with no bone displacement are treated by immobilizing the fractured bone using a cast or splint. However, in the case of fractures with displaced bones, the broken bones are repositioned before immobilization to ensure successful healing without deformation and loss of function. The realignment of fractured bone ends is performed through a process called reduction. If the...
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Related Experiment Video

Updated: Jan 17, 2026

Surgical Angiogenesis in Porcine Tibial Allotransplantation: A New Large Animal Bone Vascularized Composite Allotransplantation Model
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Vascularised Fibula Transfer for Post-traumatic Critical Tibial Bone Defects: A Systematic Review.

Sevasti P Glynou1, Ariadni Georgiannakis1, Daria Ardolino2

  • 1Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom.

Strategies in Trauma and Limb Reconstruction
|September 22, 2025
PubMed
Summary

Vascularised free fibula grafts (VFFG) show high success in reconstructing critical tibia defects after trauma, with excellent bone union and flap survival. However, high complication rates necessitate further research for optimal patient outcomes.

Keywords:
Bone reconstructionCritical bone defectFemoral reconstructionFibula flapFree fibula flapFree fibular graftLoss of bone substancePedicled vascularised fibular graft

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Area of Science:

  • Orthopedic Surgery
  • Trauma Reconstruction
  • Microsurgery

Background:

  • Managing critical post-traumatic tibial bone defects presents significant challenges.
  • Vascularised free fibula grafts (VFFG) offer a versatile solution for bone defect reconstruction.
  • The comparative effectiveness of VFFG against other methods like bone transport and Masquelet remains unclear.

Purpose of the Study:

  • To systematically review and assess the safety and effectiveness of free fibula flaps in reconstructing critical tibia defects following trauma.
  • To evaluate union rates, flap survival, and complication profiles associated with VFFG.

Main Methods:

  • A systematic literature search was conducted across five databases for English-language studies up to August 2024.
  • Inclusion criteria focused on adult patients undergoing VFFG for trauma-induced tibial bone defects.
  • Bias was assessed using the ROBINS-I tool, and studies with non-traumatic injuries or without fibula transfer were excluded.

Main Results:

  • Fifteen studies with 83 patients were included, with most VFFGs performed using a single-barrel approach (89.7%).
  • High average union rates (93.08%) and flap survival (100% in most studies) were observed.
  • Overall complication rates were substantial (39.98%), with stress fractures being common (35.5%), and revision rates varied significantly.

Conclusions:

  • Vascularised free fibula grafts are effective for reconstructing large segmental tibia defects post-trauma, demonstrating high union and flap survival.
  • High complication rates and significant study heterogeneity limit definitive conclusions on VFFG superiority.
  • Further prospective comparative studies are essential to fully elucidate the role and optimize the application of VFFG.