Intercalary Non Vascularized Fibular Graft in Pediatric Forearm Bone Defects - Post Chronic Osteomyelitis

Introduction: For bridging gap in bone defects created by tumor excision, trauma or as sequelae to infection, various treatment modalities are described including iliac crest graft, cortical tibial graft, allograft, bone transport using the principles of Ilizarov, fibula as an intercalary bone graft and vascularized fibula. Various implants used for fixation are wires, screws, plates, and ring or monorail fixator. Free non vascularized fibula is a popular substitute for this method because of its easy accessibility and minimal donor site morbidity. It has the advantage of being a much simpler procedure and avoids the use of costly implants making it a more feasible and practical solution for bone defects in developing countries. The present study was aimed at finding the results of it in bone gap created after debridement of radius/ulna following chronic osteomyelitis in pediatric population. Material and methods: 12 children of age 4-13 years with diagnosis of chronic osteomyelitis of forearm bones were included in the study. In first stage adequate bone and soft tissue debridement was done. In radial chronic osteomyelitis, to maintain radial length and DRUJ, distractor application was done. Distractor was removed after about 3 weeks and then, “press fit” free non vascularized fibular graft was applied and fixed with intramedullary K wire. The limb was immobilized in plaster till union of fibula at both ends. Results: The average per operative gap at time of grafting was 7 cm (range 4-8 cm). Union was achieved at both ends in all cases in 12-18 weeks with no major complication. One ulnar osteomyelitis case had delayed union at one site which gradually healed. At about 1 year children had good forearm range of motion. Conclusion: Non-vascularized fibular grafting is a good option for bone defects in paediatric population provided adequate debridement, fixation and immobilization has been done.