title: Reconstruction of bone defects after osteomyelitis with nonvascularized fibular graft: a retrospective study in twenty-six children.
abstract: BACKGROUND
  Persistent infection, soft-tissue fibrosis, and damage to periosteum compound the treatment of children with a bone defect following osteomyelitis. We report on a series of twenty-six patients treated with nonvascularized fibular graft and intramedullary fixation.
  
  
  METHODS
  The series included eleven boys and fifteen girls (mean age, 6.8 years; range, three to twelve years) with gap nonunion after osteomyelitis. Initial treatment involved thorough debridement and sequestrectomy. When the infection was quiescent as indicated by inflammatory parameters, nonvascular fibular grafting with intramedullary Kirschner wire fixation (with or without additional external fixation) was performed. The time to union was noted, and a subgroup analysis was performed to correlate the size of the bone defect with the time to union.
  
  
  RESULTS
  The mean duration of follow-up was 3.02 ± 0.74 years (range, 1.3 to 4.2 years), and the mean time to union was 38.76 ± 12.02 weeks (range, fifteen to sixty weeks). There was a weak positive correlation between the time to union and the preoperative bone defect size (Pearson correlation coefficient, 0.699). The mean time to union was 31.7 ± 11.5 weeks for a defect of <4 cm, 36.6 ± 9 weeks for a defect of 4 to 6 cm, and 51 ± 6.7 weeks for a defect of >6 cm. Delayed union was seen at one end of the fibular graft in four (15%) of the patients and was treated with plate fixation. One patient had recurrence of infection. Limb-length discrepancy (range, 2 to 5 cm) was seen in all patients in whom the lower limb was involved and was treated with a shoe lift.
  
  
  CONCLUSIONS
  This series illustrates the potential benefits of staged sequestrectomy and nonvascular fibular grafting for the treatment of gap nonunion following osteomyelitis in children. The procedure is simple, does not require specialized training or equipment, and has a low complication rate.
authors: Sancheti Institute for Orthopaedics and Rehabilitation, 16 Shivaji Nagar, Pune 411 005, Maharashtra, India.
authors: Sandeep
authors: S
authors: Patwardhan
authors: Ashok K
authors: AK
authors: Shyam
authors: Rustom Adi
authors: RA
authors: Mody
authors: Parag K
authors: PK
authors: Sancheti
authors: Rujuta
authors: R
authors: Mehta
authors: Hardik
authors: H
authors: Agrawat
mesh_terms: D016025:Bone Transplantation; D001842:Bone and Bones / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D003646:Debridement; D005260:Female; D005360:Fibula / Q000098:blood supply / Q000637:transplantation*; D005594:Fracture Fixation, Intramedullary; D006801:Humans; D008297:Male; D010019:Osteomyelitis / Q000150:complications / Q000601:surgery*; D019651:Plastic Surgery Procedures; D012189:Retrospective Studies; D014947:Wounds and Injuries / Q000601:surgery*