Ten adults were studied two to seven years after resection of a fibula for use as a free vascularised bone graft. Six had no symptoms in the donor leg, four had some aching, weakness or paraesthesia and three had definite weakness of the long toe flexors and extensors. All knees and ankles were clinically and radiologically stable, but the distal fibular remnant was osteoporotic in nine patients. Gait analysis of the donor leg and the contralateral normal leg showed definite differences, which could be attributed to weakness of the deep muscles caused by loss of their normal origin and to the change in load transmission through the fibula.

Seven patients with segmental defects of both bones of the forearm had reconstruction operations using a vascularised fibular graft to bridge the radius. Reasonable forearm rotation was preserved with full elbow movements and satisfactory hand function.

We describe a new method of reconstruction after resection of tumours of the proximal tibia by grafting and arthrodesis of the knee. Two separate vascularised bone grafts from the ipsilateral limb were used, one a gastrocnemius-pedicled femoral graft and the other a pedicled fibular graft. An anatomical study of the gastrocnemius-pedicled femoral graft was made. The method was shown to be practical and reproducible. One patient with osteosarcoma has a successful result with no recurrence at two-and-a-half years.

Three women with osteoarthritis of the knee presented after sudden worsening of their symptoms. In each case this was found to be due to a stress fracture of the tibia. With treatment by rest and reduced activity, the fracture healed uneventfully in all three patients.

Five cases of congenital pseudarthrosis of the tibia successfully treated by a free vascularised fibular graft are described. Follow-up ranged from 5 to 34 months with a mean of 17.5 months. The technique, which includes radical excision of abnormal bone and soft tissue around the pseudarthrosis, also permits primary bone lengthening, and correction of deformity. The early results indicate that satisfactory bony union is achieved in a relatively short period of time.

An operation is described in which a microvascular technique was used to transfer a living fibula, with its vascular pedicle intact, to replace the lower end of the radius after massive resection for giant-cell tumour. Angiography carried out six weeks later showed that the grafted bone was viable. Six months after operation the transplanted fibula showed no osteoporosis or bone resorption and bony union at the junction of host and graft.