Similar hypertrophy of a vascularized iliac crest and fibula bone graft for a tibial defect one decade later

Abstract 

Twenty years ago, priorities for vascularized bone grafts for segmental tibial defects were still ambiguous; and a battle for supremacy arose between the fibula and iliac crest as the donor site of choice. The fibula has since proved to be more versatile for larger defects, and this strong cortical bone has often been observed to undergo rapid hypertrophy in response to mechanical stresses. The long-term fate of vascularized iliac bone grafts (VIBG) is less well known, as this donor site is not commonly used today in this role. Thus, an unexpected return by our last patient with a VIBG more than a decade ago surprised us by his excellent result where unanticipated graft hypertrophy and remodeling approximated the appearance of the original tibia. When compared to a fibula bone graft performed at the same time, a similar long-term outcome was observed, suggesting that the iliac crest as a donor site for tibial defects may be more useful than heretofore appreciated.