Free Fibula Flap in Traumatic Femoral Bone Reconstruction: A 10-year Review

Introduction: The loss of femoral bone substance represents a major therapeutic issue. When the loss of bone substance is extensive, or the local condition is unfavourable, there are few satisfactory solutions. In this study, we share our experience of large femoral bone reconstruction by free fibula flap.Materials and methods: A retrospective monocentric chart review (2007-2017) was performed for 26 patients after receiving a pure bone-free fibula flap operation. The times of consolidation and hypertrophy of the graft were analysed according to the fixation with a 2-year follow-up.Results:The time to consolidation was 8.7 months (range, 6-15) for double plates, 7.2 months (range, 5-11) for locked plates, 6 months (range, 5-7) for external fixators and plate blades and 8 months (range, 7-9) for intramedullary nails. Full weight-bearing was resumed at an average of 6.5 months (range, 5-10) postoperatively. It was authorised at 7 months (range, 5-10) for patients fixed by double plate, at 6.3 months (range, 5-9) for those fixed by a locked plate, at 5.5 months (range, 5-6) for those fixed by an external fixator or plate blade and at 7 months for those fixed by an intramedullary nail.Conclusion: Free fibula flap remains reliable in the face of a great loss of bone material after trauma, with high consolidation rates. The choice of fixation must be reasoned and should offer a compromise between stability, allowing consolidation and hypertrophy of the graft, and rigidity, exposing the risk of massive osteosynthesis dismantling. Other multicentric studies, including more patients, should be carried out to compare the techniques of fixation.