Free Non-vascular Fibular Graft in Non-union of Long Bones: A Clinical Study

Introduction: Non-union of long bones due to bone loss or infection is very common. Treatment of this non-union is done by bone grafting. The grafts are usually removed from the iliac crest, proximal tibia or fibula. Non-vascularized cortical fibular grafts have been used for non-union of long bones since long time. It provides structural strength and resistance to infection along with infrequent donor site morbidity, associated with removal of fibular graft, has popularized its use. Materials and Methods: A prospective study was conducted from June 2012 to June 2014 on a total of 20 cases with ununited long bone fractures, post-traumatic, and post-infective bone defects. Mean age was 42.3 years. M: F - 2.3:1. We evaluated all patients at regular follow-up for clinical and radiological union. Result: Overall union was achieved in 85% of cases. Refracture occurred in 1 (5%) cases in lower limb. Superficial infection occurred in 2 cases which was treated successfully with antibiotic therapy. Graft resorption occurred in 2 (10%) cases. Use of free non-vascularized bone graft in selected patients with suitable recipient bed is a simple and cost-effective procedure with excellent results. Discussion: Non-union of long bones is a difficult clinical situation, challenging in terms of management. Different treatment options that can be considered are use of vascularized bone graft, bone segment transport using Ilizarov principle (in case of bone defect), use of bone substitutes or use of conventional free non-vascularized bone grafts. Among free non-vascularized bone grafts, fibula offers an easily accessible site. It is easy to harvest, being a superficial bone with very low donor site morbidity if peroneal nerve and vessels are protected. Conclusion: Non-vascularized fibular grafting along with adequate internal or external fixation, is a good option for management of non-union of long bones.