Long-term results of free vascularized fibular graft. A clinical and radiographic evaluation

Seven patients who had free vascularized fibular grafts for bone defects > 6 cm (mean, 16.6 cm) were studied retrospectively. There were 5 cases of tumor, 1 pseudoarthrosis, and 1 chronic osteomyelitis. The average followup period was 9.2 years (range, 5.2-11.3 years). Of the 5 patients with grafts to the lower limb, 1 showed a 30% reduction in bone width as seen on anteroposterior radiographs, whereas 4 patients had increases ranging from 44% to 100% (average, 66%). There were 4 graft stress fractures, of which 1 developed eventual shortening of 2.5 cm. One graft had pseudoarthrosis involving the proximal graft-host junction that required secondary procedures with autogenous cancellous bone grafting, with eventual limb-length shortening of 5 cm. All other graft-recipient junctions healed primarily. The Functional Evaluation Score ranged from 60% to 100% of normal function (mean, 85%). Three patients were able to return to sports participation. Mild weakness of the extensor hallucis longus in the donor limb was observed in 5 patients. Two patients had mild loss of plantar flexion, and 4 had limitation of dorsiflexion affecting the ankle of the donor limb.