TREATMENT OF POSTTRAUMATIC SEGMENTAL BONE DEFECTS OF THE TIBIA THROUGH THE RECONSTRUCTION WITH NON-VASCULARISED ILIAC CREST BONE GRAFT VERSUS MICROSURGICAL DOUBLE-BARREL VASCULARISED FIBULAR FLAP TRANSFER

摘要

Purpose: The treatment of segmental bone defects of the tibia after high-energy calf trauma is demanding for both, orthopaedic and plastic surgeons. Multiple treatment options are available, including non-vascularised bone grafts, allografts, bone substitutes, callus distraction, and free vascularised bone transfers. We shall present, herein, two small series of patients with major segmental defects of the tibia treated by reconstruction of the tibia with non-vascularised iliac crest bone grafts (NVIBG) and micro-surgically transferred double-barrel fibular osteomusculocutaneous flap. Materials and Methods: Patients with segmental bone defects of the tibia, 5 cm or more in length, have been included in the two series. The bone reconstruction of the tibia was performed by means of non-vascularised bone grafts harvested from the iliac crest and double-barrel fibular osteomusculocutaneous flap. Bone fixation has been ensured through external fixation in two cases and screws and initial external fixation followed by early conversion to locking plate internal fixation in the other cases. Results: In all cases included in the two series, bone union has been achieved. No case of irreversible graft loss or infection occurred in the process. Stress fractures developed in the cases treated by non-vascularised iliac crest bone grafts reconstruction. Time to bone union was of 25 months in the cases treated with non-vascularised iliac crest bone graft and, 5 to 8 months in the cases treated with double-barrel free vascularised fibular graft. Conclusions: The use of double-barrel free vascularised fibular flap was successful and it is the best option in the management of segmental tibial defects. Treatment with nonvascularised iliac crest graft can be successful in segmental bone defects of the tibia not exceeding 10 cm, but this requires a longer recovery time.