Fixation and reconstruction of severe tibial shaft fractures with vascularized fibular grafting.
BACKGROUND
Based on the considerable experience for management of combined bone and composite soft-tissue defects in the limbs by free vascularized fibula or osteocutaneous fibular flap grafting, the authors present the effective alternative for management of the severe comminuted tibial shaft fractures in one-stage reconstructive technique.


METHODS
Twenty-six patients were male and 12 were female, and their mean age was 32 years (range 15-57 years). Ten tibial shaft fractures were closed and 28 were open. Based on the AO classification, there were 12 group C1 fractures and 24 group C3 fractures according to the fracture pattern and degree of comminution.


RESULTS
With the exception of eight cases that were delayed for 3-5 days for primary treatment in another hospital, 30 cases were treated on an emergency basis within an average of 12 h since the initial injury (range 6-22). Normal healing occurred in 31 fractures with a mean healing time of 21 weeks (range 18-24 weeks). Delayed union in 7 with a mean of 32 weeks (range 28-41 weeks), and there were no nonunion and infections. The vascularized fibula allows for fast bone fusion. In this context, the grafted fibula segment appeared to be a valuable reconstructive tool that offered good fracture stabilization and vascularised bone graft.


CONCLUSIONS
The attached fibular flap can also provide a large piece of mobile skin to cover the soft-tissue defect in grade III open-tibial fractures. It demonstrates that this early free vascularized fibula graft is a useful and effective option for treating the severe comminuted tibial shaft fractures.
Department of Orthopedics, The General Hospital of PLA, Lanzhou, 333 Southern Binhe Road, Lanzhou 730050, Gansu, People's Republic of China. zhenpingok@163.com
Ping
P
Zhen
Xing-Yan
XY
Liu
Hao
H
Lu
Xu-Sheng
XS
Li
D000293:Adolescent; D000328:Adult; D005260:Female; D005360:Fibula / Q000637:transplantation*; D018460:Fractures, Comminuted / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011859:Radiography; D019651:Plastic Surgery Procedures / Q000379:methods*; D013524:Surgical Flaps; D013978:Tibial Fractures / Q000000981:diagnostic imaging / Q000601:surgery*; D055815:Young Adult