Outcome Analysis of Fibular Graft (Both Vascularized and Non-Vascularized) in the Management of Bone Defects

Kumaresan, N (2020) Outcome Analysis of Fibular Graft (Both Vascularized and Non-Vascularized) in the Management of Bone Defects. Masters thesis, Madras Medical College, Chennai.

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Abstract

INTRODUCTION: Reconstruction of skeletal bone defects following trauma, tumour resection and infective resorption are always challenging for orthopaedic surgeons. Several methods have evolved in the past decades for management of bone defects though each have their own different advantages and disadvantages. Incidence of open fractures is about 4.5 million per year in India. During early 20th century, when there was extensive soft tissue damage, bone loss and contamination of fracture site, amputation was the life-saving measure. In cases requiring limb salvage, the different methods of reconstruction include Papineau technique, Distraction Osteogenesis, Endoprosthesis usage, Induced membrane technique and fibular grafts. Smaller defects of up to 2 cm can be managed with Reamer Irrigation Aspiration (RIA) technique and Bone Marrow Injection. AIM OF THE STUDY: 1. The aim of the study is to determine the clinical outcome of fibular grafts which includes both vascularized and non-vascularized, in the management of bone defects. 2. To assess radiological union, functional outcome and satisfactory ambulation of the patients MATERIALS AND METHODS: This prospective and retrospective study was done at Rajiv Gandhi Government General Hospital, Chennai. In our study, 20 cases of long bone defects resulting after trauma, infective resorption and tumour resection were analyzed. The patients were treated with vascularized and non-vascularized fibular grafts based on the size of the defect and the additional soft tissue loss. Regular follow-up of patients once in 4 weeks till union and then once in 3 months. Radiological union, Functional score were measured using ASAMI scoring and bone hypertrophy using Deer-Boer Index. RESULTS: There was good union of bone graft of 50% (10 patients) using ASAMI Bone Union Grading system with 60% of patients showing satisfactory bone hypertrophy in patients treated with vascularized and non-vascularized fibular grafts. 40% patients developed complication with infection being major complication in 6 out of 20 patients. CONCLUSION: Both vascularized and Non-vascularized fibular grafts resulted in good bony union and good functional outcome with faster and better results in lower limbs than in upper limbs. Though vascularized fibular grafting is a complex procedure with multi-speciality approach and increased chances of infection, it is essential in cases of larger bone defects with additional soft tissue loss.

Item Type: Thesis (Masters)
Additional Information: 221712005
Uncontrolled Keywords: Vascularized fibular grafts, Non-Vascularized fibular grafts, Bone Defects.
Subjects: MEDICAL > Orthopaedics
Depositing User: Subramani R
Date Deposited: 13 Feb 2021 12:28
Last Modified: 13 Feb 2021 12:28
URI: http://repository-tnmgrmu.ac.in/id/eprint/14090

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