Vascularized fibular graft is one of the well accepted methods in the treatment of large bone defect of femoral shaft. But bone fixation with Ender nails through the same incision of bone graft has never been reported. We performed vascularized fibular graft and bone fixation with Ender nails through single medial skin incision and permitted physiologic stress. We achieved early radiologic union and medullary widening and the patient could return to work 9 months after the accident. We would like to report such an experience of treatment with the reference of literature.
Previous management of chronic osteomyelitis has included antibiotic therapy, radical debridement, skin-grafting, distant cross-leg flaps, and local muscle flaps. Each of these modalities of treatment has limitations. However, over the last 20 years, vascularized fibular bone grafts have proved to be a valuable method of reconstruction of skeletal defects in the extremities following both infected and uninfected skeletal nonunions unresponsive to conventional methodology. We evaluated the efficacy of vascularized fibular graft in the treatment of chronic osteomyelitis of long bone. From August 1988 to June 1995, fourteen cases of chronic osteomyelitis of long bone which were followed for an average of 3 years duration were treated by vascularized fibular graft at the Department of Orthopaedic Surgery, Korea University Hospital.
The results were as follows; 1. Even if the long tubular bone infection was uncontrolled, vascularized fibular graft could be performed and it was highly resistent to local infection.
2. Twelve cases (85.7%) out of a fourteen cases had primarily obtained bony union.
3. Free vascularized fibular graft is significant and reliable porcedure of bone grafting for the treatment of chronic osteomyelitis of long tubular bones.