Open versus percutaneous fibular graft harvesting in long bone nonunion surgery: A comparative cohort study

The traditional open harvesting method used in fibular grafting is a well-established reconstructive technique, but it is associated with donor-site morbidity. However, percutaneous harvesting has been introduced as a minimally invasive method to reduce trauma while preserving graft adequacy.

A retrospective comparative analysis was conducted to measure the outcomes of percutaneous versus open fibular graft harvesting. Studied variables included patient demographics, intraoperative parameters (harvest time, estimated blood loss, incision length), and postoperative outcomes (pain scores, analgesia requirements, donor-site complications, and functional recovery).

Among 34 patients undergoing non-vascularized fibular grafting for long-bone non-unions, 16 (47%) underwent graft harvest using an open approach, and 18 (53%) using a percutaneous technique. Baseline demographic and surgical characteristics were generally similar between the groups. The percutaneous approach was associated with significantly lower postoperative pain scores at 1 week (VAS 7.39 ± 0.61 vs. 8.19 ± 0.66, p = 0.0008), 1 month (4.56 ± 0.78 vs. 6.13 ± 0.66, p < 0.0001), and 3 months, shorter graft harvest time, reduced intraoperative blood loss, and smaller incision length. Sensory deficits of the peroneal nerve were observed exclusively in the open group (37.5% vs. 0%, p = 0.004). Both techniques achieved comparable union rates (100% vs. 88.9%, p = 0.169), graft incorporation during follow-up (100% vs. 83.3%, p = 0.087), overall complication rates, and reoperation rates, with no mortality reported at one-year follow-up.

Percutaneous fibular graft harvesting offers a safe and effective alternative to the conventional open approach. It is associated with lower intraoperative morbidity and improved early postoperative recovery, without compromising graft utility or increasing complication rates. These findings support the wider adoption of minimally invasive techniques in fibular graft harvesting.