title: The outcome and complications of vascularised fibular grafts.
abstract: OBJECTIVE
  Free vascularised fibular grafting has been used for the treatment of large bony defects for more than 40 years. However, there is little information about the risk factors for failure and whether newer locking techniques of fixation improve the rates of union. The purpose of this study was to compare the rates of union of free fibular grafts fixed with locking and traditional techniques, and to quantify the risk factors for nonunion and failure.
  
  
  METHODS
  A retrospective review involved 134 consecutive procedures over a period of 20 years. Of these, 25 were excluded leaving 109 patients in the study. There were 66 men and 43 women, with a mean age of 33 years (5 to 78). Most (62) were performed for oncological indications, and the most common site (52) was the lower limb. Rate of union was estimated using the Kaplan-Meier method and risk factors for nonunion were assessed using Cox regression. All patients were followed up for at least one year.
  
  
  RESULTS
  The rate of union was 82% at two years and 97% at five years. Union was achieved after the initial procedure in 76 patients (70%) at a mean of ten months (3 to 19), and overall union was achieved in 99 patients (91%). No surgical factor, including the use of locked fixation or supplementary corticocancellous bone grafts increased the rate of union. A history of smoking was significantly associated with a risk of nonunion.
  
  
  CONCLUSIONS
  Free vascularised fibular grafting is a successful form of treatment for large bony defects. These results suggest that the use of modern techniques of fixation does not affect the risk of nonunion when compared with traditional forms of fixation, and smoking increases the risk of nonunion following this procedure. Cite this article: Bone Joint J 2017;99-B:134-8.
authors.affiliation: Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA.
authors.forename: M T
authors.initials: MT
authors.lastname: Houdek
authors.affiliation: University of California, Davis, 4860 Y Street, Suite 3800, Sacramento, CA 95817, USA.
authors.forename: C O
authors.initials: CO
authors.lastname: Bayne
authors.affiliation: Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA.
authors.forename: A T
authors.initials: AT
authors.lastname: Bishop
authors.affiliation: Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA.
authors.forename: A Y
authors.initials: AY
authors.lastname: Shin
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001859:Bone Neoplasms / Q000601:surgery*; D016025:Bone Transplantation / Q000009:adverse effects / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D005260:Female; D005360:Fibula / Q000637:transplantation; D058752:Free Tissue Flaps / Q000009:adverse effects / Q000637:transplantation*; D006085:Graft Survival / Q000502:physiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology; D012086:Reoperation; D012307:Risk Factors; D020858:Tissue and Organ Harvesting / Q000379:methods; D060053:Transplant Donor Site; D016896:Treatment Outcome; D014945:Wound Healing / Q000502:physiology; D055815:Young Adult
keywords: Free fibula; Outcome; Vascularised bone graft