Abstract
Purpose: Transfer of the vascularised fibula causes an imbalance in the lower limb due to the small calibre of the bone compared with the recipient bone (femur, tibia). “Femorisation” or “tibialisation” is slow, requiring prolonged protection with an orthesis. The doubled fibula or “shotgun” technique which maintains fibular periosteal vascularisation may overcome this inconvenience.
Material and methods: We report a series of eight free vascular shotgun fibular transfers at a mean four years follow-up (1–11). The recipient site was the lower limb in all patients who had undergone multiple operations, seven for chronic osteitis and one for chondrosarcome (five femoral supracondylar grafts, one knee arthrodesis, two metaphyseal tibial grafts). A cortico-cancellous autologous graft was associated during the same operation for six patients; Osteo-synthesis was achieved in seven cases with an external fixator and in one case with locked centromedullary nailing.
Results: The bone scintigraphy obtained in all cases at the third postoperative day showed intense uptake in the graft in six cases. We had seven cases of osteitis with no case of recurrent sepsis. Mean delay to bone healing assessed radiographically was 5.2 months. Hypertrophy of the fibula was noted at last follow-up in four cases. The external fixator was removed on the average at 6.8 months (5–9). Weight bearing was allowed in all cases with an adjustable protective orthesis. There was one fracture of the graft in a patient with a knee arthordesis which was treated with a corticocancellous autologous bone graft.
Conclusion: This series demonstrates the interest of doubling the free fibular transplant compared with other bone transfers to the lower limbs, improving the balance of the bone calibre and resistance. For patients with loss of supracondylar femoral bone, we describe a widened posterior access allowing the preparation of the recipient site with a single installation for the graft harvesting and fibular transfer.
The abstracts were prepared by Pr. Jean-Pierre Courpied (General Secretary). Correspondence should be addressed to him at SOFCOT, 56 rue Boissonade, 75014 Paris, France
