title: Free vascularised fibular grafting combined with a locking plate for massive bone defects in the lower limbs: a retrospective analysis of fibular hypertrophy in 18 cases.
abstract: OBJECTIVE
  Free vascularised fibular grafting (FVFG) could be a good option for the restoration of massive bone defects in lower limbs when combined with use of a locking plate. The progress of fibular hypertrophy is closely related to regain of function, as well as to prevention of stress fractures. Multiple variables affecting fibular hypertrophy were investigated in the current study to elucidate correlative factors.
  
  
  METHODS
  Eighteen patients with a massive bone defect in a lower limb reconstructed by FVFG combined with a locking plate were retrospectively enrolled in the current study. The degree of fibular hypertrophy was calculated based on the measurements from anteroposterior imaging at regular intervals of 3 months, 6 months, 1, 2 and 3 years postoperatively. Repeated measures analysis of variance was employed to evaluate and compare correlative factors including gender (male vs. female), age distribution (<30 years vs. >30 years), site (femur vs. tibia) and length of bone defect (6-10 cm vs. >10 cm), previous number of operations (once vs. more than twice) and concomitant infection (detected vs. non-detected).
  
  
  RESULTS
  All defects could be successfully repaired by FVFG and bone union was achieved uneventfully. The degree of fibular hypertrophy was 0.14%, 11.27%, 31.53%, 58.14% and 71.81% retrospectively at the five follow-up time points. Statistical analysis revealed that the above-mentioned factors did not affect the progress of fibular hypertrophy.
  
  
  CONCLUSIONS
  FVFG could be a good choice for the reconstruction of massive bone defects when combined with a locking plate. Factors including gender, age distribution, site and length of bone defects, number of previous operations and infection do not impact the progress of fibular hypertrophy, which implies that intrinsic factors might play an important role in restoration.
authors.affiliation: Department of Orthopaedic Surgery, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University, Shanghai 200233, PR China.
authors.forename: You-Shui
authors.initials: YS
authors.lastname: Gao
authors.forename: Zi-Sheng
authors.initials: ZS
authors.lastname: Ai
authors.forename: Xiao-Wei
authors.initials: XW
authors.lastname: Yu
authors.forename: Jia-Gen
authors.initials: JG
authors.lastname: Sheng
authors.forename: Dong-Xu
authors.initials: DX
authors.lastname: Jin
authors.forename: Sheng-Bao
authors.initials: SB
authors.lastname: Chen
authors.forename: Xiang-Guo
authors.initials: XG
authors.lastname: Cheng
authors.forename: Chang-Qing
authors.initials: CQ
authors.lastname: Zhang
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D001860:Bone Plates; D016025:Bone Transplantation / Q000009:adverse effects / Q000379:methods*; D005260:Female; D005264:Femoral Fractures / Q000150:complications* / Q000503:physiopathology / Q000601:surgery; D005360:Fibula / Q000098:blood supply / Q000473:pathology / Q000637:transplantation*; D005500:Follow-Up Studies; D006801:Humans; D006984:Hypertrophy / Q000209:etiology; D008297:Male; D008875:Middle Aged; D020127:Recovery of Function; D012189:Retrospective Studies; D017678:Sex Distribution; D016896:Treatment Outcome; D055815:Young Adult