Comparison of internal bone transport and vascularized fibular grafting for femoral bone defects.
OBJECTIVE
To compare results between vascularized fibular grafting and internal bone transport for large bone defects of the femur.


METHODS
Retrospective review of patients.


METHODS
University teaching hospitals.


METHODS
This study included 37 patients with femoral bone loss: 20 patients were treated with internal bone transport and seventeen patients were treated with vascularized fibular grafting.


METHODS
The outcomes investigated were external fixation time, external fixation index, bone results (union, infection, deformity, leg length discrepancy), and functional results.


RESULTS
The mean amount of filled defect was 8.4 cm with internal bone transport and 8.9 cm with vascularized fibular grafting. The external fixation index was 1.4 months/cm with internal bone transport and 1 month/cm with vascularized fibular grafting. The bone results and functional results of the internal bone transport were excellent in 65% and 0%, good in 5% and 45%, fair in 5% and 40%, poor in 25% and 15%, respectively, whereas those of the vascularized fibular grafting were excellent in 35% and 0%, good in 25% and 47%, fair in 5% and 35%, and poor in 35% and 18%.


CONCLUSIONS
With vascularized fibular grafting, careful monitoring of circulation and early intervention surgery is necessary to avoid vascular failure. With internal bone transport, repeated radical debridement until control of infection is achieved, bone grafting at the docking site for early union, and avoiding stress fracture are recommended to improve bone results.
Song
Hae-Ryong
HR
Department of Orthopaedic Surgery, Gyeong-Sang National University School of Medicine, Chinju, South Korea. songhae@nongae.gsnu.ac.kr
Kale
Amod
A
Park
Hyung-Bin
HB
Koo
Kyung-Hoi
KH
Chae
Dong-Ju
DJ
Oh
Chang-Wug
CW
Chung
Duck-Whan
DW
D000293:Adolescent; D000328:Adult; D000368:Aged; D016025:Bone Transplantation / Q000379:methods*; D016267:External Fixators; D005260:Female; D005264:Femoral Fractures / Q000000981:diagnostic imaging* / Q000601:surgery*; D005269:Femur / Q000098:blood supply* / Q000601:surgery; D005360:Fibula / Q000098:blood supply* / Q000637:transplantation*; D005593:Fracture Fixation, Internal / Q000379:methods*; D017102:Fracture Healing / Q000502:physiology; D005597:Fractures, Open / Q000000981:diagnostic imaging / Q000601:surgery; D006085:Graft Survival; D006785:Hospitals, University; D006801:Humans; D018889:Ilizarov Technique; D015601:Injury Severity Score; D008297:Male; D008833:Microcirculation / Q000502:physiology; D008875:Middle Aged; D011379:Prognosis; D011859:Radiography; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D016896:Treatment Outcome