Osteomyelitis is one of diseases that still prevalent in developing country. The incidence of osteomyelitis in children might be catastrophic due to its potential to disrupt bone growth, devitalized soft tissue, and most common for chronic condition is bone gap which lead to long-term physical and psychosocial complications, which makes it’s reconstructions is quite challenging. A novel vascularized fibular grafting is a simple, cost effective, single stage procedure and accepted method with better outcome for gap non unions in children. A serial cases of three chronic osteomyelitis patients with long term evaluation after vascularized fibular grafting.
The series included three cases of chronic osteomyelitis children with bone gap size each (6.53 cm; 0.68 cm;1.10 cm). Initial treatment involved thorough debridement and sequestrectomy. When the infection was quiescent as indicated by inflammatory parameters, vascular fibular grafting with intramedullary and screw fixation was performed. The vascularized fibula was grafted and fixated appropriately at the recipient site. The time to union was noted, and longterm evaluation performed to correlate the size of the bone defect with the time to union, complication and walking capacity of child
Average length of vascularized fibular graft was 9.8 cm (range 6.04 cm - 12.72 cm). All patients had good radiological healing without recorded nonunion or malunion. No patient developed deep infection or implant failure. Secondary bone healing was achieved in 3 patients. After follow-up of 24 months, from radiological finding, the fibula bone increase in size of tibia although the angulation is unacceptable ( 42.4° ) but according to New Mobility Score (NMS), functional of 3 patients is very satisfying which 6 for 1 patients that walking with aid and 9 for 2 patients that can keep up with squatting, standing on tiptoe, and walking
Vascularized fibular grafting can effectively repair the bone gap, improve blood supply, and help to treat leg length disperancy which have more advantages either anatomical and functional outcome in chronic osteomyelitis children with bone gap complication
