Traditional management of comminuted tibia fractures with massive bone and soft tissue defect includes soft tissue coverage and bone grafting. However, this method requires a large flap and a substantial amount of bone graft. Acute shortening can reduce the amount of required soft tissue and bone graft. We report a case of open tibia and fibula fracture with severe bone and soft tissue defect that was successfully treated by acute shortening of the tibia with immediate fibular strut bone graft and then by gradual lengthening of the tibia at its proximal metaphysis.
Bone Transplantation ; Fibula ; Tibia ; Transplants

Avascular osteonecrosis of the femoral head is a common disease in orthopedic clinics. If the diagnosis can be made before collapse of the femoral head, the hip joint may probably be preserved by means of core decompression with or without bone grafting, osteotomies, as well as nonvascularized or vascularized bone grafting. Local pedicled bone grafts and free vascularized bone grafts can transfer the vascularized bone grafts into the necrotic area of the femoral head, which not only can replace necrotic bone with healthy bone, but also establish a new source of blood supply to the femoral head. The success rate in patients with different stages of osteonecrosis of femoral head was 80% at 5 years follow up. Free vascularized bone grafting for the treatment of avascular osteonecrosis of the femoral head can obtain a higher success rate.
Bone Transplantation ; methods ; Femur Head Necrosis ; surgery ; Fibula ; transplantation ; Humans

Child ; Fibula ; transplantation ; Humans ; Male ; Periosteum ; transplantation ; Wrist Joint ; surgery

Adult ; Bone Transplantation ; Fibula ; transplantation ; Humans ; Male ; Maxilla ; surgery ; Osteogenesis, Distraction ; methods ; Surgical Flaps ; Zygoma ; transplantation

Masquelet technique is one of the modalities for the treatment of long bone defect. Using cancellous bone graft to fill the bone defect is always a concern in children due to the small size of their iliac crest and open growth plate. We reported a case of 13-year-old male who presented with gap non-union of middle third of tibia. We applied a modified Masquelet technique by using only the cortical fibular graft instead of cancellous bone to fill the space surrounded by induced membrane. Fibula was used as a nonvascularized strut graft and matched stick graft to achieve complete union. We concluded that nonvascularized fibula grafting is an easy and effective option to fill the bone defect in children in the second stage of Masquelet technique.
Male ; Child ; Humans ; Adolescent ; Fracture Healing ; Bone Transplantation/methods* ; Fibula/transplantation* ; Tibia/surgery* ; Ilium/transplantation*

This article reviews the history and development of as well as the results using a fibular graft by vascular anastomosis for the treatment of avascular osteonecrosis of the femoral head. Vascular anastomosed fibular grafting has been reported to be successful for patients with early stages and precollapse osteonecrosis of the femoral head. The method can be used to preserve the hip joint function. Vascular anastomosed fibular grafting can be the transfer of vascularized bone grafts into the necrotic portions of the femoral head. Such a procedure, in addition to replacing necrotic bone with healthy bone, also establishes a new source of circulating blood of the femoral head. Free avascularized bone grafting for the treatment of avascular osteonecrosis of the femoral head may lead to higher rates of successful treatment and superior to those of core decompression and nonoperative treatment.
Anastomosis, Surgical ; Bone Transplantation ; Femur Head ; surgery ; Femur Head Necrosis ; surgery ; Fibula ; transplantation ; Humans ; Treatment Outcome

Adolescent ; Adult ; Child ; Child, Preschool ; Female ; Fibula ; transplantation ; Humans ; Male ; Middle Aged ; Periosteum ; transplantation ; Radius ; surgery ; Transplantation, Autologous ; Ulna ; surgery

Adult ; Female ; Femoral Neck Fractures ; surgery ; Fibula ; transplantation ; Fracture Fixation, Internal ; Humans ; Male ; Middle Aged

OBJECTIVE: To investigate the position change of the fibular bone after maxillary reconstruction by free fibular flap and to analyze the factors affecting the position change. METHODS: Patients who underwent maxillary reconstruction by free fibular flap in the Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology from November 2012 to November 2016 were enrolled in this study. CT scans 1 week and 1 year postoperatively were collected and stored in DICOM format. The ProPlan CMF software was used to reconstruct the CT scans and separate the maxilla and each segment of the fibular flap. The Geomagic Control software was used to measure the long axis direction vector of each fibular segment. And the position change direction was recorded. The patients were divided into groups according to the use of the fibula or titanium plate to reconstruct the zygomaticmaxillary buttress. RESULTS: A total of 32 patients were enrolled. Among them, 21 were in the titanium plate group and 11 in the fibula bone group. The angle between the long axis of the fibular segment and the X axis in the X-Y plane was 95.65°±53.49° and 95.53°±52.77°, 1 week and 1 year postoperatively, and there was no statistical difference (P>0.05). The angle between the long axis of the fibular segment and the X axis in the X-Z plane was 96.88°±69.76° and 95.33°±67.42°, respectively, with statistical difference (P=0.0497). The angular changes of the long axis of the fibular segment in the titanium plate group and the fibular bone group were 3.23°±3.93° and 1.94°±1.78°, respectively, and the angular changes in the X-Z plane were 6.02°±9.89° and 3.27°±2.31°, respectively. There was no significant difference between the groups (P>0.05). The long axis changes of the fibular segment in the X-Y plane for reconstruction of the anterior alveolar, posterior alveolar, and buttress were 3.13°±3.78°, 2.56°±3.17°, and 5.51°±4.39°, respectively. There was a statistical difference (P = 0.023) between the posterior and buttress. In the X-Z plane, theses were 4.94°±4.75°, 5.26°±10.25°, 6.69°±6.52°, respectively. There was no statistical difference among the three groups (P>0.05). The main positional deviation directions of the titanium plate group and the fibular bone group were interior and superior sides, and there was no statistical difference between the two groups (P>0.05). CONCLUSION One year postoperatively, the position of the free fibular flap was changed compared with 1 week postoperatively. The position of the free fibular flap was mainly changed to the interior and superior sides.
Bone Transplantation ; Fibula/diagnostic imaging* ; Free Tissue Flaps ; Humans ; Mandibular Reconstruction ; Maxilla/surgery*

OBJECTIVETo investigate the clinical efficacy of the pith decompression of the femoral head and fibular allograft transplantation in the treatment of early stage avascular necrosis.

METHODSFrom January 2004 to November 2008, 32 hips of 25 patients with avascular necrosis of femoral head of Ia-IIIb period were treated by the pith decompression of the femoral head and fibular allograft transplantation, hollow lag screw fixation, included 17 males and 8 females, aged from 20 to 55 years old (39.1 years on average). Preoperative pain was from 2 to 14 months (means 5.5 months). All patients were applied on conventional X-ray films, MRI examination, Harris score.

RESULTSThe patients were followed up for 12 to 48 months (means 36.4 months). X-ray film showed 21 hips of 18 cases improved,6 hips of 4 cases unchanged, no collapse of articular surface, 3 hips of 2 cases deterioration, 2 hips of 1 case failed. Preoperative Harris score was (77.0 +/- 8.0) and postoperative (90.6 +/- 2.5), there was a significant difference (t = 1.67, P < 0.05).

CONCLUSIONPith decompression of the femoral head and fibular allograft transplantation in the treatment of early stage avascular necrosis of femoral head has advantage of joint function in bed-ridden after a short time, quick recovery,clinical symptoms improved. Its short-term efficacy is certain but long-term efficacy is still need further observation.

Adult ; Decompression, Surgical ; methods ; Female ; Femur Head Necrosis ; surgery ; Fibula ; transplantation ; Humans ; Male ; Middle Aged ; Transplantation, Homologous