• DOI:10.1302/0301-620X.92B2.22758
• Corpus ID: 18545904

Management of combined nonunion and limb-length discrepancy after vascularised fibular grafting.

@article{AbdelGhani2010ManagementOC,
  title={Management of combined nonunion and limb-length discrepancy after vascularised fibular grafting.},
  author={Hisham Abdel-Ghani and Walid Atef Ebeid and Hassan Magdy El-Barbary},
  journal={The Journal of bone and joint surgery. British volume},
  year={2010},
  volume={92 2},
  pages={
          267-72
        }
}

• H. Abdel-Ghani, W. Ebeid, H. El-Barbary
• Published 1 February 2010
• Medicine
• The Journal of bone and joint surgery. British volume

We describe the management of nonunion combined with limb-length discrepancy following vascularised fibular grafting for the reconstruction of long-bone defects in the lower limb after resection of a tumour in skeletally immature patients. We operated on nine patients with a mean age of 13.1 years (10.5 to 14.5) who presented with a mean limb-length discrepancy of 7 cm (4 to 9) and nonunion at one end of a vascularised fibular graft, which had been performed previously, to reconstruct a bone defect after resection of an osteosarcoma. Reconstruction was carried out using a ring fixator secured with correction by half pins of any malalignment, compression of the site of nonunion and lengthening through a metaphyseal parafocal osteotomy without bone grafting. The expected limb-length discrepancy at maturity was calculated using the arithmetic method. Solid union and the intended leg length were achieved in all the patients. Excessive scarring and the distorted anatomy from previous surgery in these patients required other procedures to be performed with minimal exposures and dissection in order to avoid further compromise to the vascularity of the graft or damage to neurovascular structures. The methods which we chose were simple and effective in addressing these complex problems.