Role of Non Vascularized Fibula Graft in the Management of Post Osteomyelitic Bone Defects in Children

Volume 8 | Issue 1 | January-April 2022 | Page: 24-30 | Anil Agarwal, Ankur, Ankit Jain


Authors: Anil Agarwal MS Ortho. [1], Ankur MS Ortho. [1], Ankit Jain D Ortho. [1]

[1] Department of Paediatric Orthopaedics, Chacha Nehru Bal Chikitsalaya, Geeta Colony, Delhi, India.

Address of Correspondence
Dr. Anil Agarwal,
Department of Paediatric Orthopaedics, Chacha Nehru Bal Chikitsalaya, Geeta Colony, Delhi, India.


Osteomyelitis continues to be widely prevalent in low socioeconomic countries. The challenges associated with the disease include weakened pathological bone, cavities, pathological fractures, non-union and gaps. This article discusses the uses of non-vascularized fibular graft for the management of the sequelae of osteomyelitis. A review of literature reveals this technique to be quite successful with fewer complications. Being technically less demanding and easy, this procedure remains an important tool in the management of bone defects due to osteomyelitis in children.
Keywords: Osteoarticular infection, Reconstruction, Bone graft


1. Ono CM, Albertson KS, Reinker KA, Lipp EB. Acquired radial club hand deformity due to osteomyelitis. J Pediatr Orthop. 1965;15:161-8.
2. Malki A, Wong-Chung J, Hariharan V. Centralization of ulna for infected nonunion of radius with extensive bone loss: a modified Hey-Groves procedure. Injury. 2000;31:345-9.
3. Rasool MN. Pyogenic osteomyelitis of the forearm bones in children. SA Orthopedic Journal. 2011;10:18-24.
4. Zhang X, Duan L, Li Z, Chen X. Callus distraction for the treatment of acquired radial club hand deformity after osteomyelitis. J Bone Joint Surg Br. 2007;89:1515-8.
5. Netrawichien P. Radial clubhand-like deformity resulting from osteomyelitis of the distal radius. J Pediatr Orthop. 1995;15:157-60.
6. Wirbel R, Hermans K. Surgical treatment of chronic osteomyelitis in children admitted from developing countries. Afr J Paediatr Surg. 2014;11:297-303.
7. Lloyd-Roberts GC. Treatment of defects in children by establishing cross union with the radius. J Bone Joint Surg Br. 1973;55:327-30.
8. Allsopp BJ, Hunter-Smith DJ, Rozen WM. Vascularized versus nonvascularized bone grafts: what is the evidence? Clin Orthop Relat Res. 2016;474:1319-27.
9. Ma XY, Liu B, Yu HL, Zhang X, Xiang LB, Zhou DP. Induced membrane technique for the treatment of infected forearm nonunion: a retrospective study. J Hand Surg Am. 2021:S0363-5023(21)00402-0.
10. Patwardhan S, Shyam AK, Mody RA, Sancheti PK, Mehta R, Agrawat H. Reconstruction of bone defects after osteomyelitis with nonvascularized fibular graft: a retrospective study in twenty-six children. J Bone Joint Surg Am. 2013;95:e56, S1.
11. Malik S, Joshi S, Tank JS. Cystic bone tuberculosis in children- a case series. Indian J Tuberc. 2009;56:220-4.
12. Rasool MN, Govender S, Naidoo KS. Cystic tuberculosis of bone in children. J Bone Joint Surg Br. 1994;76:113-7.
13. Agarwal A, Kant KS, Kumar A, Shaharyar A, Verma I, Suri T. Lytic lesions of distal radius in children: a rare tubercular presentation. Hand Surg. 2014;19:369-74.
14. Agarwal A, Gupta N, Mishra M, Agrawal N, Kumar D. Primary epiphyseal and metaepiphyseal tubercular osteomyelitis in children A series of 8 case. Acta Orthop Belg. 2016;82:797-805.
15. Collert S, Isacson J. Chronic sclerosing osteomyelitis (Garré). Clin Orthop Relat Res. 1982;164:136-40.
16. Segev E, Hayek S, Lokiec F, Ezra E, Issakov J, Wientroub S. Primary chronic sclerosing (Garré’s) osteomyelitis in children. J Pediatr Orthop B. 2001;10:360-4.
17. Malkawi H, Shannak A, Sunna’ P. Active treatment of segmental defects of long bones with established infection. A prospective study. Clin Orthop Relat Res. 1984;184:241-8.
18. Agarwal A, Yogendra Raj R, Shanker M. Clinicoradiological outcomes following single-stage treatment using external fixator, copious bone grafting and high dose antibiotics for infected postosteomyelitic nonunion of femoral shaft. J Pediatr Orthop B. 2021;30:85-92.
19. Agarwal A, Raj RY, Gupta S, Shanker M. Osteosynthesis of postosteomyelitic forearm defects in children using a modified bone grafting technique: the fibular intramedullary bridging bone and additional grafting (FIBBAG). J Hand Surg Asian Pac Vol. 2020;25:13-9.
20. Pawar DP, Ninawe DT, Sheth DBA. A novel technique of ulna strut grafting for post-septic radial clubhand deformity: Case series of 4 patients with review of literature. J Clin Orthop Trauma. 2020;11(Suppl 5):S883-S888.
21. Al-Zahrani S, Harding MG, Kremli M, Khan FA, Ikram A, Takroni T. Free fibular graft still has a place in the treatment of bone defects. Injury. 1993;24:551-4.
22. Enneking WF, Edy JL, Burchardt H. Autogenous cortical bone grafts in the reconstruction of segmental skeletal defects. J Bone Joint Surg Am. 1980;62:1039-58.
23. Yajima H, Kobata Y, Shigematsu K, Kawamura K, Kawate K, Tamai S, et al. Vascularized fibular grafting in the treatment of methicillin-resistant Staphylococcus aureus osteomyelitis and infected nonunion. J Reconstr Microsurg. 2004;20:13-20.
24. Khan SN, Cammisa FP Jr, Sandhu HS, Diwan AD, Girardi FP, Lane JM. The biology of bone grafting. J Am Acad Orthop Surg. 2005;13:77-86.
25. Onuba O. Chronic osteomyelitis. Use of ipsilateral fibular graft for diaphyseal defects of the tibia. Trop Geogr Med. 1988;40:139-42.
26. Fowles JV, Lehoux J, Zlitni M, Kassab MT, Nolan B. Tibial defect due to acute haematogenous osteomyelitis: treatment and results in twenty-one children. J Bone Joint Surg Br. 1979;61:77-81.
27. Tuli SM. Bridging of bone defects by massive bone grafts in tumorous conditions and in osteomyelitis. Clin Orthop Relat Res. 1972;87:60-73.
28. Müller-Färber JA, Wittner B. Autogenous fibula grafting of a radial defect complicating acute hematogenous osteomyelitis in a child. Arch Orthop Trauma Surg. 1987;106:186-91.
29. Daoud A, Saighi-Bouaouina A. Treatment of sequestra, pseudarthroses, and defects in the long bones of children who have chronic hematogenous osteomyelitis. J Bone Joint Surg Am. 1989;71:1448-68.
30. Onuoha KM, Bassey AO, Omotola O, Adedapo A. Tibia gap nonunion following sequestrectomy treated with a non vascularized fibula strut graft. Niger J Clin Pract. 2021;24:1096-99.
31. Steinlechner CW, Mkandawire NC. Non-vascularised fibular transfer in the management of defects of long bones after sequestrectomy in children. J Bone Joint Surg Br. 2005;87:1259-63.
32. Kaewpornsawan K, Eamsobhana P. Free non-vascularized fibular graft for treatment of large bone defect around the elbow in pediatric patients. Eur J Orthop Surg Traumatol. 2017;27:895-900.
33. Baumbach SF, Hobohm L, Wozasek GE. A treatment strategy for complex cases of osteomyelitis in children and its applicability on three exemplary cases. J Pediatr Orthop B. 2011;20:432-5.
34. Zalavras CG, Femino D, Triche R, Zionts L, Stevanovic M. Reconstruction of large skeletal defects due to osteomyelitis with the vascularized fibular graft in children. J Bone Joint Surg Am. 2007;89:2233-40.
35. Pinto D, Mehta R, Agashe M. Lengthening after nonvascularized fibula grafting for large postinfective bone defect: a case report with long follow-up. JBJS Case Connect. 2021;11.
36. Gupta G, Shah MM, Raibagkar S, Shah A, Rabbi Q. Reconstruction of post-osteomyelitis 1st ray phalangeal loss by reverse dermis cross toe flap and fibula bone grafting: A rare case report. Foot (Edinb). 2021;49:101782.
37. Swamy MK, Rathi A, Gupta V. Results of non-vascularised fibular grafting in gap non-union of long bones in paediatric age group. J Clin Orthop Trauma. 2013;4:180-4.
38. Yadav SS. Dual-fibular grafting for massive bone gaps in the lower extremity. J Bone Joint Surg Am. 1990;72:486-94.

How to Cite this Article:  Agarwal A, Ankur, Jain A | Role of Non Vascularized Fibula Graft in the Management of Post Osteomyelitic Bone Defects in Children | International Journal of Paediatric Orthopaedics | January-April 2022; 8(1): 24-30.

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