Periosteum Preservation, the Key to Fibular Regeneration Following 21 Non-vascularised Free Fibular Grafts in Children
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AbstractIntroduction: Vascularised fibular bone graft has been the choice technique for fibular bone graft but is technically
demanding. Non-vascularised free fibular bone graft harvest, a relatively easier procedure when bundled with periosteum preservation, gives a unique opportunity to study bone regeneration. We prospectively investigated the regenerated fibula quantitatively and possible clinical implications.

Methods: A total of 21 fibulas from otherwise healthy extremities were harvested using a circumferential periosteum
preservation technique in 16 children. All the operations were done at Chacha Nehru Bal Chikitsalaya, Delhi, India.
A minimum of 10% of total length at either end was preserved for ankle stability and safety to deep peroneal nerve.
Evaluations of pain, gait, and neuromuscular examination and radiological assessment were done at zero, 3, 6 months and thereafter. Fibular regeneration and bony incorporation into the grafted area was quantified longitudinally in comparison to identical points on ipsilateral tibia at preoperatively defined points.

Results: About 64% of total fibular length was available for use as graft. There was regeneration and bony incorporation of grafted fibula similar to the preoperative dimensions as early as 6 months in 71% of cases. There were no clinical morbid findings as assessed at 6-month follow-up despite non-continuity observed in 29% of cases. Predominant site for noncontinuity was middle third–distal third junction.

Conclusion: Periosteum-preserving non-vascularised fibula grafting was a low-morbidity procedure. In two thirds of the
cases, there was regeneration of fibula comparable to preoperative dimensions as early as 6 months.
All Author(s) ListA. Kumar, A. Agarwai, W. W. Chau, B. K. W. Ng and J. C. Y. Cheng
Name of ConferenceThe 36th Annual Congress of the Hong Kong Orthopaedic Association (HKOA)
Start Date of Conference05/11/2016
End Date of Conference06/11/2016
Place of ConferenceHong Kong
Country/Region of ConferenceHong Kong
LanguagesEnglish-United Kingdom

Last updated on 2018-22-01 at 09:15