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Journal of Bone and Joint Surgery - British Volume, Vol 87-B, Issue 9, 1259-1263.
doi: 10.1302/0301-620X.87B9.15734  
Copyright © 2005 by British Editorial Society of Bone and Joint Surgery
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Non-vascularised fibular transfer in the management of defects of long bones after sequestrectomy in children

C. W. B. Steinlechner, BSc(Hons), MBBS, FRCS(Eng), FRCS(Tr & Orth), Consultant Orthopaedic Surgeon1; and N. C. Mkandawire, MCh(Orth), FCS(ECSA), Senior Lecturer, Consultant Orthopaedic Surgeons2

1 North Devon District Hospital, Raleigh Hill, Barnstaple, Devon EX31 4JB, UK.
2 Department of Surgery, University of Malawi, College of Medicine, P/B 360, Chichiri, Blantyre 3, Malawi.

Correspondence should be sent to Dr. N. C. Mkandawire; e-mail: ncmkandawire{at}malawi.net

The management of chronic osteomyelitis requires the excision of necrotic and infected material followed by the prolonged administration of antibiotics. Sequestrectomy may be required before an involucrum has formed, resulting in a longitudinal bone defect. This can be difficult to fill. Vascularised grafts are complicated by a high rate of recurrent infection and thrombosis.

We have managed defects of long bones in children after sequestrectomy by the use of non-vascularised fibular grafts harvested subperiosteally and held by an intramedullary Kirschner wire. Eight children underwent this procedure. In six the tibia was involved and in one each the humerus and radius. One patient was lost to follow-up. Six grafts united at both ends within 12 weeks. The seventh developed an infected nonunion distally which united after further debridement. One patient required a further sequestrectomy which did not compromise union.

We have found this to be a straightforward technique with reliable results and were able to salvage the limb in all the seven patients who were reviewed.




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Alternative technique of Kirschner wire fixation
Anil Agarwal
J Bone Joint Surg Br Online, 30 Sep 2005 [Full text]

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Hip, Knee, Trauma, Upper limb, Foot & Ankle, Paediatrics, Oncology, Spine, Arthroplasty, General