Archives of Orthopaedic and Trauma Surgery

, Volume 128, Issue 9, pp 941–944 | Cite as

Rigid bridging of massive femur defect using double vascularized fibula graft with hydroxyapatite

  • Toshihiro Matsuo
  • Takashi Sugita
  • Shoji Shimose
  • Tadahiko Kubo
  • Toru Sunagawa
  • Yuji Yasunaga
  • Mitsuo Ochi
Orthopaedic Surgery


The presence of large and massive segmental defects of the diaphyseal bone following tumor resection is a significant problem for orthopedic surgeons. Double or folded free vascularized fibula graft (FVFG) is used in massive femur defects and is considered to be a reliable reconstructive procedure. However, folded or double fibula grafts cannot prevent stress fractures. Here, a novel surgical procedure for bridging of massive femur defects using double FVFG and hydroxyapatite with autogenous bone grafts to prevent stress fractures is reported.


Femur defect Vascularized fibula graft Hydroxyapatite Autogenous bone graft Surgical treatment 


  1. 1.
    Hsu RW, Wood MB, Sim FH, Chao EY (1997) Free vascularised fibular grafting for reconstruction after tumour resection. J Bone Joint Surg Br 79:36–42PubMedCrossRefGoogle Scholar
  2. 2.
    Ihara K, Doi K, Yamamoto M, Kawai S (1998) Free vascularized fibular grafts for large bone defects in the extremities after tumor excision. J Reconstr Microsurg 14:371–376PubMedGoogle Scholar
  3. 3.
    Koskinen EV (1978) Wide resection of primary tumors of bone and replacement with massive bone grafts: an improved technique for transplanting allogeneic bone grafts. Clin Orthop Relat Res 134:302–319PubMedGoogle Scholar
  4. 4.
    Ghazavi MT, Stockley I, Yee G, Davis A, Gross AE (1997) Reconstruction of massive bone defects with allograft in revision total knee arthroplasty. J Bone Joint Surg Am 79:17–25PubMedCrossRefGoogle Scholar
  5. 5.
    Kotz R, Ritschl P, Trachtenbrodt J (1986) A modular femur-tibia reconstruction system. Orthopedics 9:1639–1652PubMedGoogle Scholar
  6. 6.
    Tsuchiya H, Tomita K, Minematsu K, Mori Y, Asada N, Kitano S (1997) Limb salvage using distraction osteogenesis. A classification of the technique. J Bone Joint Surg Br 79:403–411 (Erratum in: J Bone Joint Surg Br 79:693)PubMedCrossRefGoogle Scholar
  7. 7.
    Yajima H, Tamai S, Mizumoto S, Ono H (1993) Vascularised fibular grafts for reconstruction of the femur. J Bone Joint Surg Br 75:123–128PubMedGoogle Scholar
  8. 8.
    Hou SM, Liu TK (1992) Reconstruction of skeletal defects in the femur with ‘two-strut’ free vascularized fibular grafts. J Trauma 33:840–845PubMedGoogle Scholar
  9. 9.
    Jones NF, Swartz WM, Mears DC, Jupiter JB, Grossman A (1988) The “double barrel” free vascularized fibular bone graft. Plast Reconstr Surg 81:378–385PubMedCrossRefGoogle Scholar
  10. 10.
    Muramatsu K, Ihara K, Doi K, Shigetomi M, Hashimoto T, Taguchi T (2006) Reconstruction of massive femur defect with free vascularized fibula graft following tumor resection. Anticancer Res 26:3679–3683PubMedGoogle Scholar
  11. 11.
    Tamai N, Myoui A, Tomita T, Nakase T, Tanaka J, Ochi T, Yoshikawa H (2002) Novel hydroxyapatite ceramics with an interconnective porous structure exhibit superior osteoconduction in vivo. J Biomed Mater Res 59:110–117PubMedCrossRefGoogle Scholar
  12. 12.
    Ito Y, Tanaka N, Fujimoto Y, Yasunaga Y, Ishida O, Agung M, Ochi M (2004) Bone formation using novel interconnected porous calcium hydroxyapatite ceramic hybridized with cultured marrow stromal stem cells derived from Green rat. J Biomed Mater Res A 69:454–461PubMedCrossRefGoogle Scholar
  13. 13.
    Enneking WF, Dunham W, Gebhardt MC, Malawar M, Pritchard DJ (1993) A system for the functional evaluation of reconstructive procedures after surgical treatment of tumors of the musculoskeletal system. Clin Orthop 286:241–246PubMedGoogle Scholar
  14. 14.
    Mankin HJ, Gebhardt MC, Jennings LC, Springfield DS, Tomford WW (1996) Long-term results of allograft replacement in the management of bone tumors. Clin Orthop Relat Res 324:86–97PubMedCrossRefGoogle Scholar
  15. 15.
    Tomford WW (1995) Transmission of disease through transplantation of musculoskeletal allografts. J Bone Joint Surg Am 77:1742–1754PubMedGoogle Scholar
  16. 16.
    Capanna R, Morris HG, Campanacci D, Del Ben M, Campanacci M (1994) Modular uncemented prosthetic reconstruction after resection of tumours of the distal femur. J Bone Joint Surg Br 76:178–186PubMedGoogle Scholar
  17. 17.
    Horowitz SM, Glasser DB, Lane JM, Healey JH (1993) Prosthetic and extremity survivorship after limb salvage for sarcoma. How long do the reconstructions last? Clin Orthop Relat Res 293:280–286PubMedGoogle Scholar
  18. 18.
    Noonan KJ, Leyes M, Forriol F, Canadell J (1998) Distraction osteogenesis of the lower extremity with use of monolateral external fixation. A study of two hundred and sixty-one femora and tibiae. J Bone Joint Surg Am 80:793–806PubMedGoogle Scholar
  19. 19.
    Muramatsu K, Ihara K, Shigetomi M, Kawai S (2004) Femoral reconstruction by single, folded or double free vascularised fibular grafts. Br J Plast Surg 57:550–555PubMedCrossRefGoogle Scholar
  20. 20.
    Mankin HJ, Doppelt SH, Sullivan TR, Tomford WW (1982) Osteoarticular and intercalary allograft transplantation in the management of malignant tumors of bone. Cancer 50:613–630PubMedCrossRefGoogle Scholar
  21. 21.
    de Boer HH, Wood MB (1989) Bone changes in the vascularised fibular graft. J Bone Joint Surg Br 71:374–378PubMedGoogle Scholar
  22. 22.
    Hierner R, Wood MB (1995) Comparison of vascularised iliac crest and vascularised fibula transfer for reconstruction of segmental and partial bone defects in long bones of the lower extremity. Microsurgery 16:818–826PubMedCrossRefGoogle Scholar
  23. 23.
    Mizumoto S, Tamai S, Goshima J, Yajima H, Yoshii T, Fukui A, Masuhara K (1986) Experimental study of vascularized tibiofibula graft in inbred rats: a preliminary report. J Reconstr Microsurg 3:1–11PubMedCrossRefGoogle Scholar
  24. 24.
    O’Brien BM, Gumley GJ, Dooley BJ, Pribaz JJ (1988) Folded free vascularized fibula transfer. Plast Reconstr Surg 82:311–318PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2008

Authors and Affiliations

  • Toshihiro Matsuo
    • 1
  • Takashi Sugita
    • 2
  • Shoji Shimose
    • 3
  • Tadahiko Kubo
    • 3
  • Toru Sunagawa
    • 3
  • Yuji Yasunaga
    • 1
  • Mitsuo Ochi
    • 3
  1. 1.Department of Artificial Joints and Biomaterials, Graduate School of Biomedical SciencesHiroshima UniversityHiroshimaJapan
  2. 2.Department of Orthopaedic SurgeryHiroshima Prefectural HospitalHiroshimaJapan
  3. 3.Department of Orthopaedic Surgery, Graduate School of Biomedical SciencesHiroshima UniversityHiroshimaJapan

Personalised recommendations