Strategies in Trauma and Limb Reconstruction

Register      Login

VOLUME 15 , ISSUE 2 ( May-August, 2020 ) > List of Articles

Original Article

Non-vascularised Fibular Autograft for Reconstruction of Paediatric Bone Defects: An Analysis of 10 Cases

Gerard A Sheridan, John T Cassidy, Aaron Donnelly, Maria Noonan, Paula M Kelly, David P Moore

Citation Information : Sheridan GA, Cassidy JT, Donnelly A, Noonan M, Kelly PM, Moore DP. Non-vascularised Fibular Autograft for Reconstruction of Paediatric Bone Defects: An Analysis of 10 Cases. 2020; 15 (2):84-90.

DOI: 10.5005/jp-journals-10080-1462

License: CC BY-NC-SA 4.0

Published Online: 03-03-2021

Copyright Statement:  Copyright © 2020; The Author(s).


Aim and objective: Fibular autograft is a known technique for the reconstruction of traumatic and non-traumatic bone defects in both adult and paediatric populations. We aim to describe our outcomes using various stabilisation methods for non-vascularised fibular autograft to reconstruct both benign and malignant tumours in a paediatric population in a National Paediatric Centre over the past 14 years. Materials and methods: This was a retrospective review of 10 paediatric cases with non-traumatic primary bone defects in a National Paediatric Centre. Criteria for inclusion were all non-traumatic primary bone defects requiring reconstruction with a non-vascularised fibular autograft in the diaphyseal or metaphyseal regions of the bone. The primary outcome measures were union and time to union (weeks). Time to union was illustrated using Kaplan–Meier curves. Secondary outcome measures included postoperative fracture, infection (deep and superficial), time to full weight-bearing and all-cause revision surgery. Results: The mean length of follow-up was 63 months for the entire cohort (9–168, SD = 48.6). There was no loss to follow-up. Six lesions were located in the tibia, two in the femur and the remaining two were located in the ulna and third metacarpal. Union was ultimately achieved in 8 of the 10 patients using this donor autograft. The mean time to union was 28 weeks (10–99, SD = 29.8). There were four complications of autograft fracture. The mean time to fracture was 17 weeks (9–32, SD = 10.71). In all four of these cases, the patient achieved union at final follow-up. There were two superficial and two deep infections recorded. Three resolved with the use of antimicrobial therapy and one deep infection ultimately required insertion of an intercalary prosthesis to treat the infected non-union of the fibular graft site. Conclusion: The use of non-vascularised fibular autograft for the reconstruction of tumours is an effective surgical technique in a paediatric cohort. We report the largest known series of malignant paediatric tumours treated with this technique to date. Clinical significance: Non-vascularised fibular autograft is successful in the reconstruction of large bone defects secondary to malignant paediatric bone tumours.

  1. STROBE checklist Available from
  2. Murray JA, Schlafly B. Giant-cell tumors in the distal end of the radius. Treatment by resection and fibular autograft interpositional arthrodesis. J Bone Joint Surg Am 1986;68(5):687–694. DOI: 10.2106/00004623-198668050-00008.
  3. Fernyhough JC, White JI, LaRocca H. Fusion rates in multilevel cervical spondylosis comparing allograft fibula with autograft fibula in 126 patients. Spine 1991;16(10 Suppl):S561–S564. DOI: 10.1097/00007632-199110001-00022.
  4. Kashayi-Chowdojirao S, Vallurupalli A, Chilakamarri VK, et al. Role of autologous non-vascularised intramedullary fibular strut graft in humeral shaft nonunions following failed plating. J Clin Orthop Trauma 2017;8(Suppl. 2):S21–S30. DOI: 10.1016/j.jcot.2016.12.006.
  5. Rengsen P, Tiong K, Teo Y, et al. Reconstruction of the second metatarsal with non-vascularised fibular graft following en-bloc resection for giant cell tumour: a case report. Malays Orthop J 2013;7(3):15–17. DOI: 10.5704/MOJ.1311.001.
  6. Akiyama T, Clark JC, Miki Y, et al. The non-vascularised fibular graft: a simple and successful method of reconstruction of the pelvic ring after internal hemipelvectomy. J Bone Joint Surg Br 2010;92(7): 999–1005. DOI: 10.1302/0301-620X.92B7.23497.
  7. Keizer SB, Kock NB, Dijkstra PD, et al. Treatment of avascular necrosis of the hip by a non-vascularised cortical graft. J Bone Joint Surg Br 2006;88(4):460–466. DOI: 10.1302/0301-620X.88B4.16950.
  8. Devireddy SK, Senthil Murugan M, Kishore Kumar RV, et al. Evaluation of non-vascular fibula graft for mandibular reconstruction. J Maxillofac Oral Surg 2015;14(2):299–307. DOI: 10.1007/s12663-014-0657-1.
  9. Lenze U, Pohlig F, Knebel C, et al. Autologous fibula transplantation for reconstruction of bone defects. Orthopade 2017;46(8):648–655. DOI: 10.1007/s00132-017-3442-2.
  10. Allsopp BJ, Hunter-Smith DJ, Rozen WM. Vascularized versus nonvascularized bone grafts: what is the evidence? Clin Orthop Relat Res 2016;474(5):1319–1327. DOI: 10.1007/s11999-016-4769-4.
  11. Lenze U, Kasal S, Hefti F, et al. Non-vascularised fibula grafts for reconstruction of segmental and hemicortical bone defects following meta-/diaphyseal tumour resection at the extremities. BMC Musculoskelet Disord 2017;18(1):289. DOI: 10.1186/s12891-017-1640-z.
  12. Schuh R, Panotopoulos J, Puchner SE, et al. Vascularised or non-vascularised autologous fibular grafting for the reconstruction of a diaphyseal bone defect after resection of a musculoskeletal tumour. Bone Joint J 2014;96-B(9):1258–1263. DOI: 10.1302/0301-620X.96B9.33230.
  13. Krieg AH, Hefti F. Reconstruction with non-vascularised fibular grafts after resection of bone tumours. J Bone Joint Surg Br 2007;89(2): 215–221. DOI: 10.1302/0301-620X.89B2.17686.
  14. Jamshidi K, Mirkazemi M, Izanloo A, et al. Locking plate and fibular strut-graft augmentation in the reconstruction of unicameral bone cyst of proximal femur in the paediatric population. Int Orthop 2018;42(1):169–174. DOI: 10.1007/s00264-017-3648-2.
  15. Swamy MK, Rathi A, Gupta V. Results of non-vascularised fibular grafting in gap non-union of long bones in paediatric age group. J Clin Orthop Trauma 2013;4(4):180–184. DOI: 10.1016/j.jcot.2013. 09.001.
  16. Lampasi M, Magnani M, Donzelli O. Aneurysmal bone cysts of the distal fibula in children: Long-term results of curettage and resection in nine patients. J Bone Joint Surg Br 2007;89(10):1356–1362. DOI: 10.1302/0301-620X.89B10.19375.
  17. Erickson C, Kaufmann W, Budimirovic D, et al. Best practices in fragile X syndrome treatment development. Brain Sci 2018;8(12):224. DOI: 10.3390/brainsci8120224.
  18. Villemagne T, Bonnard C, Accadbled F, et al. Intercalary segmental reconstruction of long bones after malignant bone tumor resection using primary methyl methacrylate cement spacer interposition and secondary bone grafting: the induced membrane technique. J Pediatr Orthop 2011;31(5):570–576. DOI: 10.1097/BPO.0b013e31821ffa82.
  19. Ortiz-Cruz E, Gebhardt MC, Jennings LC, et al. The results of transplantation of intercalary allografts after resection of tumors. A long-term follow-up study. J Bone Joint Surg Am 1997;79(1):97–106. DOI: 10.2106/00004623-199701000-00010.
  20. Mankin HJ, Springfield DS, Gebhardt MC, et al. Current status of allografting for bone tumors. Orthopedics 1992;15(10):1147–1154.
  21. Zekry KM, Yamamoto N, Hayashi K, et al. Reconstruction of intercalary bone defect after resection of malignant bone tumor. J Orthop Surg (Hong Kong) 2019;27(1):2309499019832970. DOI: 10.1177/2309499019832970.
  22. Agarwal A, Kumar D, Agrawal N, et al. Ankle valgus following non-vascularized fibular grafts in children-an outcome evaluation minimum two years after fibular harvest. Int Orthop 2017;41(5): 949–955. DOI: 10.1007/s00264-017-3403-8.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.