title: Free non-vascularized fibular graft for treatment of large bone defect around the elbow in pediatric patients.
abstract: BACKGROUND
  Large bone defect is a challenging problem in orthopedics practice. Several methods are available for bridging of these bone defects, including cancellous bone graft, free vascularized fibula graft, and bone transport with external ring fixator. The aim of this study was to describe our experience in nine pediatric cases of free non-vascularized autogenous fibular strut bone graft in which large bone defect and bone loss of >7 cm was caused by open fracture and infective nonunion around the elbow joint.
  
  
  OBJECTIVE
  To describe our experience in nine pediatric cases of free non-vascularized autogenous fibular strut bone graft in which large bone defect and bone loss of >7 cm was caused by open fracture and infective nonunion around the elbow joint.
  
  
  METHODS
  This retrospective review was conducted in patients with large bone defect with bony gap >7 cm. Time to union, range of motion, complications, Mayo Elbow Performance Score, and Foot and Ankle Disability Index (FADI) were recorded.
  
  
  RESULTS
  The large bone defects included in this study were managed by free non-vascularized fibular strut bone grafts (FNVFG) that were harvested subperiosteally. Nine patients with a mean age of 11 years (range: 6-17) underwent this procedure. Nine grafts (100%) united at both ends within an average of 9 weeks (range: 8-14). Mean length of defect was 9.3 cm (range: 8-13 cm). Mean postoperative Mayo Elbow Performance Score was significantly higher than the mean preoperative score (98.33 vs. 64.44, respectively; p < 0.001). Three fibulae were observed for hypertrophy. Mean Foot and Ankle Disability Index score was 100 both preoperatively and postoperatively in all patients.
  
  
  CONCLUSIONS
  Free non-vascularized fibular graft is a simple procedure and a reliable method for bridging large bone defect or loss caused by open fracture and/or infection around the elbow in pediatric patients.
authors.affiliation: Department of Orthopedics Surgery, Faculty of Medicine, Siriraj Hospital, Mahidol University, 2 Wanglung Road Bangkoknoi, Bangkok, Thailand.
authors.forename: Kamolporn
authors.initials: K
authors.lastname: Kaewpornsawan
authors.affiliation: Department of Orthopedics Surgery, Faculty of Medicine, Siriraj Hospital, Mahidol University, 2 Wanglung Road Bangkoknoi, Bangkok, Thailand. Peerajite@gmail.com.
authors.forename: Perajit
authors.initials: P
authors.lastname: Eamsobhana
mesh_terms: D000293:Adolescent; D016025:Bone Transplantation / Q000379:methods*; D002648:Child; D004551:Elbow Joint / Q000502:physiology / Q000601:surgery*; D005260:Female; D005360:Fibula / Q000637:transplantation; D005597:Fractures, Open / Q000503:physiopathology / Q000601:surgery*; D005599:Fractures, Ununited / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D006810:Humeral Fractures / Q000503:physiopathology / Q000601:surgery; D008297:Male; D010019:Osteomyelitis / Q000503:physiopathology / Q000601:surgery; D011885:Radius Fractures / Q000503:physiopathology / Q000601:surgery; D016059:Range of Motion, Articular / Q000502:physiology; D012189:Retrospective Studies; D013524:Surgical Flaps; D014182:Transplantation, Autologous; D016896:Treatment Outcome; D014458:Ulna Fractures / Q000503:physiopathology / Q000601:surgery
keywords: Bone defect; Non-vascularized fibular graft; Open fracture; Osteomyelitis