title: Management of post-traumatic bone defects of the tibia using vascularised fibular graft combined with Ilizarov external fixator.
abstract: BACKGROUND
  Post-traumatic bone defects of the tibia present a difficult reconstructive challenge. Various methods of reconstruction are available, such as allografts, vascularised fibular graft (either free or pedicled) and bone transport technique.
  
  
  METHODS
  Fourteen patients with an average age of 34.1 years at operation (range, 12-65) with post-traumatic bony defects of the tibia were selected for reconstruction with vascularised fibular graft combined with Ilizarov external fixation. There were 12 male and two female. The size of the bony gap was 10.4 cm (range, 7-13) and the average length of the fibula used was 16.4 cm (range, 14-21).
  
  
  RESULTS
  The mean follow up period was 20.4 months (range, 10-37). All patients had bony union at both proximal and distal ends of the fibula primarily except one patient that required secondary iliac bone graft at the distal end of the fibula to obtain union. The average time for bone healing was 3.9 months (range, 3-9). The average time spent in Ilizarov frame was 5.9 months (range, 5-11). Unprotected full weight-bearing was achieved within an average of 7.3 months (range, 6-12).
  
  
  CONCLUSIONS
  Vascularised fibular bone graft combined with an Ilizarov frame is a successful approach to safely and effectively reconstruct bone defects of the tibia. It has the advantages of vascularised fibular bone grafts together with the biomechanical advantages of Ilizarov frame that allows weight bearing to start almost immediately after surgery. This leads to a good outcome regarding the union and function.
authors.affiliation: El-Hadra University Hospital, Alexandria Medical School, Egypt. Electronic address: semayamicro71@yahoo.com.
authors.forename: Ahmad El-Sayed
authors.initials: Ael-S
authors.lastname: Semaya
authors.affiliation: El-Hadra University Hospital, Alexandria Medical School, Egypt.
authors.forename: Ehab
authors.initials: E
authors.lastname: Badawy
authors.affiliation: El-Hadra University Hospital, Alexandria Medical School, Egypt.
authors.forename: Mohammad
authors.initials: M
authors.lastname: Hasan
authors.affiliation: El-Hadra University Hospital, Alexandria Medical School, Egypt.
authors.forename: Ramy Mohammad
authors.initials: RM
authors.lastname: El-Nakeeb
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D016025:Bone Transplantation / Q000379:methods*; D002648:Child; D016267:External Fixators; D005260:Female; D005360:Fibula / Q000637:transplantation*; D005500:Follow-Up Studies; D006801:Humans; D023821:Limb Salvage / Q000379:methods*; D008297:Male; D008875:Middle Aged; D019651:Plastic Surgery Procedures; D013524:Surgical Flaps; D013977:Tibia / Q000473:pathology / Q000601:surgery*; D013978:Tibial Fractures / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome; D016474:Weight-Bearing; D055815:Young Adult
keywords: Ilizarov; Post-traumatic bone defects of the tibia; Vascularised fibular graft