Surgical technique and clinical efficacy of vascularized fibular bone graft for femoral neck defects in children with bone diseases

CHEN Guo-jing; JI Chuan-lei; WANG Feng-wei; LI Ming-hui; LI Jing; WANG Zhen

doi:10.3969/j.issn.2095-252X.2019.01.013

Abstract：Objective To explore the surgical technique and clinical efficacy of vascularized fibular bone graft for femoral neck defects in children with bone diseases.Methods From January to December, 2018, 6 patients (2 males and 4 females;aged 3-12 years, mean 8.2 years) with femoral neck defects or nonunion due to bone disease were selected.The initial operation was performed with curettage, bone grafting and internal fixation (6 cases).Five patients underwent a second operation because of the first operation failure, and the reconstruction with vascularized fibular bone flap was performed.All patients were followed up every 3 months after operation, and every 6 months after2 years.At the follow-up, the pelvic AP and hip lateral radiographs were taken to observe the tumor recurrence, healing of the bone graft, limb malformation and shortening and hip function.Results Six patients were followed up for 16 to48 months, with an average of 26.5 months.During the follow-up period, 6 patients had no recurrence.Two patients developed nonunion within 4 to 8 months after the initial operation, and 3 patients developed hip varus deformity again.The bone did not heal, but no necrosis occurred in the femoral head.One patient who underwent allogeneic bone graft reconstruction healed 3 months after surgery, without secondary surgery.The second fibular bone graft was reconstructed 3 to 6 months after surgery, with an average of 4.3 months.The grafted fibula bone flap bridged the femoral head and large trochanter, forming a firm healing.Collodiaphyseal angle correction averaged about 18 degrees.The affected limb shortening was corrected about 2 cm on average.Harris Hip score improved by an average of about30 points.Conclusions Clinical outcomes of vascularized fibular bone graft for femoral neck defects in children with bone disease is satisfactory, but the operation is difficult and requires a doctor with rich clinical experience.