Reconstruction of Tubular Bone Defects with Non Vascularized Fibular Graft

Vasantharaman, R (2007) Reconstruction of Tubular Bone Defects with Non Vascularized Fibular Graft. Masters thesis, Kilpauk Medical College, Chennai.


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INTRODUCTION: In our speciality of orthopaedics we come across many problems involving the bone and soft tissues like, fractures, infections, tumours etc., among these bony defects are a great challenge to us. These defects can be due to various causes such as post traumatic bone loss, post infective bone loss and defect resulting after excision of tumours. These defects have to be reconstructed to give better form and function to the patients. These defects can be either diaphyseal or osteoarticular. To reconstruct these defect is a surgical challenge. Surgical challenges may include primary articular defects, diaphyseal defects and salvage of other failed reconstructions. Many options are available that may be tailored to the individual's need. Autograft, allograft, prosthetic replacement or allograft prosthetic composite are established methods for reconstructions. Among the autograft and allograft reconstructions it can be done either as vascularized or nonvascularized graft. AIM: 1. To study the outcome of the nonvascularized fibular graft in reconstructing the tumour defects and gap nonunion of tubular bones. 2. To share our experience of these procedures done in our institution. MATERIALS AND METHODS: This was a retrospective study conducted at Government Royapettah Hospital between 2002 and 2006. In this period of four years we analysed the hospital records to find out the cases treated by fibular strut grafts. Among the 30 cases of various tumorous conditions that were treated by us we identified 15 cases where the defects were treated by fibular reconstruction. The list of trauma cases were also analysed and we identified 5 cases with significant bone defects for which reconstruction was done with fibular graft. So tumorous condition and trauma cases put together we had 20 cases for this study. Preoperative evaluation done for the tumour cases were complete haemogram, serum studies, radiography of appropriate parts, skeletal survey. Serum studies consisted of serum calcium, serum phosphorus and serum alkaline phosphate. CT and MRI of the lesion and near by joint were also done. It is with these investigations (MRI & CT) we identified the exact extent of the lesion, cortical / articular breach etc. Based on this wide resection was planned along with reconstructions. RESULTS: Results were based on functional outcome which was analysed according to Mankin et al criteria. Following were our results: Excellent - 10 cases, Good - 3 cases, Fair - 3 cases, Failed - 4 cases. CONCLUSION: The bony defects arising out of wide resection of the benign tumour can be successfully reconstructed with fibular graft – giving good functional outcome. Post traumatic bony defects with late presentation and cases with compromised soft tissues did not give satisfactory results with this procedure. However these bony defects can be successfully managed with fibular reconstruction when they present early to the surgeon. Our overall experience with nonvascularized fibular graft for reconstructing bony defects are encouraging, however we are aware this is a short term study and would require further evaluation and more inputs.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Reconstruction of Tubular Bone Defects ; Non Vascularized Fibular Graft.
Subjects: MEDICAL > Orthopaedics
Depositing User: Subramani R
Date Deposited: 16 Sep 2017 17:49
Last Modified: 17 Sep 2017 14:39

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