Skip to main content

Advertisement

SpringerLink
Log in

Fixation and reconstruction of severe tibial shaft fractures with vascularized fibular grafting

  • Trauma Surgery
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Introduction

Based on the considerable experience for management of combined bone and composite soft-tissue defects in the limbs by free vascularized fibula or osteocutaneous fibular flap grafting, the authors present the effective alternative for management of the severe comminuted tibial shaft fractures in one-stage reconstructive technique.

Method

Twenty-six patients were male and 12 were female, and their mean age was 32 years (range 15–57 years). Ten tibial shaft fractures were closed and 28 were open. Based on the AO classification, there were 12 group C1 fractures and 24 group C3 fractures according to the fracture pattern and degree of comminution.

Results

With the exception of eight cases that were delayed for 3–5 days for primary treatment in another hospital, 30 cases were treated on an emergency basis within an average of 12 h since the initial injury (range 6–22). Normal healing occurred in 31 fractures with a mean healing time of 21 weeks (range 18–24 weeks). Delayed union in 7 with a mean of 32 weeks (range 28–41 weeks), and there were no nonunion and infections. The vascularized fibula allows for fast bone fusion. In this context, the grafted fibula segment appeared to be a valuable reconstructive tool that offered good fracture stabilization and vascularised bone graft.

Conclusion

The attached fibular flap can also provide a large piece of mobile skin to cover the soft-tissue defect in grade III open-tibial fractures. It demonstrates that this early free vascularized fibula graft is a useful and effective option for treating the severe comminuted tibial shaft fractures.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Mashru RP, Herman MJ, Pizzutillo PD (2005) Tibial shaft fractures in children and adolescents. J Am Acad Orthop Surg 13:345–352

    PubMed  Google Scholar 

  2. Giannoudis PV, Hinsche AF, Cohen A, Macdonald DA, Matthews SJ, Smith RM (2003) Segmental tibial fractures: an assessment of procedures in 27 cases. Injury 34:756–762

    Article  CAS  PubMed  Google Scholar 

  3. Merianos P, Cambouridis P, Smyrnis P (1985) The treatment of 143 tibial shaft fractures by Ender nailing and early weight-bearing. J Bone Jt Surg 67B:576–580

    Google Scholar 

  4. Siebenrock KA, Schilling B, Jacob RP (1993) Treatment of complex tibial shaft fractures. Arguments for early secondary intramedullary nailing. Clin Orthop Relat Res 290:269–274

    PubMed  Google Scholar 

  5. Fan CY, Chiang CC, Chuang TY, Chiu FY, Chen TH (2005) Interlocking nails for displaced metaphyseal fractures of the distal tibia. Injury 36:669–674

    Article  PubMed  Google Scholar 

  6. Busse JW, Morton E, Lacchetti C, Guyatt GH, Bhandari M (2008) Current management of tibial shaft fractures: a survey of 450 Canadian orthopedic trauma surgeons. Acta Orthop 79:689–694

    Article  PubMed  Google Scholar 

  7. Doi K (1995) One-stage treatment of infected bone defects of the tibia with skin loss by free vascularized osteocutaneous grafts. Microsurgery 16:704–712

    Article  CAS  PubMed  Google Scholar 

  8. Taylor GI, Miller GDH, Ham FJ (1975) The free vascularized bone graft. A clinic extension of microvascular technique. Plast Reconstr Surg 55:533–544

    Article  CAS  PubMed  Google Scholar 

  9. Lee KS, Park JW (1999) Free vascularized osteocutaneous fibular graft to the tibia. Microsurgery 19:141–147

    Article  CAS  PubMed  Google Scholar 

  10. Taylor GI (1983) The current status of free vascularized bone grafts. Clin Plast Surg 10:185–188

    CAS  PubMed  Google Scholar 

  11. Banic A, Hertel R (1993) Double vascularized fibulas for reconstruction of large tibial defects. J Reconstr Microsurg 9:421–428

    Article  CAS  PubMed  Google Scholar 

  12. Tu YK, Yen CY, Yeh WL (2001) Reconstruction of posttraumatic long bone defect with free vascularized bone graft: good outcome in 48 patients with 6 years follow-up. Acta Orthop Scand 72:359–363

    Article  CAS  PubMed  Google Scholar 

  13. Arai K, Toh S, Tsubo K (2002) Complications of vascularized fibula graft for reconstruction of long bones. Plast Reconstr Surg 109:2301–2305

    Article  PubMed  Google Scholar 

  14. Wei FC, Chen HC, Chuang CC, Noordhoff MS (1986) Fibular osteoseptocutaneous flap: anatomic study and clinical application. Plast Reconstr Surg 78:191–199

    Article  CAS  PubMed  Google Scholar 

  15. Yajima H, Tamai S, Kobata Y, Murata K, Fukui A, Takakuba Y (2002) Vascularized composite tissue transfers or open fractures with massive soft-tissue defects in the lower extremities. Microsurgery 22:114–121

    Article  PubMed  Google Scholar 

  16. Yazar S, Lin CH, Wei FC (2004) One-stage reconstruction of composite bone and soft-tissue defects in traumatic lower extremities. Plast Reconstr Surg 114:1457–1466

    Article  PubMed  Google Scholar 

  17. Gustilo RB, Mendoza RM, Williams DN (1984) Problems in the management of type III severe open fractures: a new classification of type III open fractures. J Trauma 24:742–747

    Article  CAS  PubMed  Google Scholar 

  18. Johner R, Wruhs O (1983) Classification of tibial shaft fractures and correlation with results after rigid internal fixation. Clin Orthop Relat Res 178:7–25

    PubMed  Google Scholar 

  19. Chen ZW, Yan W (1983) Study and clinical application of the osteoseptocutaneous flap of fibular. Microsurgery 4:11–16

    Article  CAS  PubMed  Google Scholar 

  20. Karladani AH, Granhed H, Kärrholm J, Styf J (2001) The influence of fracture etiology and type on fracture healing: a review of 104 consecutive tibial shaft fractures. Arch Orthop Trauma Surg 121:325–328

    Article  CAS  PubMed  Google Scholar 

  21. Karlstrom G, Olerud S (1983) External fixation of severe open tibial fractures with the Hoffmann Frame. Clin Orthop Relat Res 180:68–77

    PubMed  Google Scholar 

  22. Gregory P, Sanders R (1995) The treatment of closed, unstable tibial shaft fractures with unreamed interlocking nails. Clin Orthop Relat Res 315:48–55

    PubMed  Google Scholar 

  23. Giannoudis PV, Papakostidis C, Roberts C (2006) A review of the management of open fractures of the tibia and femur. J Bone Jt Surg 88B:281–289

    Google Scholar 

  24. Lee YS, Lo TY, Huang HL (2008) Intramedullary fixation of tibial shaft fractures: a comparison of the unlocked and interlocked nail. Int Orthop 32:69–74

    Article  PubMed  Google Scholar 

  25. Edward CC, Simmons SC, Browner BD, Oreck SL, Weigel MC (1984) 203 open tibial fractures treated with Hoffmann external fixation. Orthop Trans 8:383–384

    Google Scholar 

  26. Court-Brown CM, Wheelwright EF, Christie J, McQueen MM (1990) External fixation for type III open tibial fractures. J Bone Jt Surg 78B:801–804

    Google Scholar 

  27. Keating JF, O’Brien PI, Blachut PA, Meek RN, Broekhuyse HM (1997) Reamed interlocking intramedullary nailing of open fractures of the tibia. Clin Orthop Relat Res 338:182–191

    Article  PubMed  Google Scholar 

  28. Beltsios M, Savvidou O, Kovanis J, Alexandropoulos P, Papagelopoulos P (2009) External fixation as a primary and definitive treatment for tibial diaphyseal fractures. Strateg Traum Limb Reconstr 4:81–87

    Article  Google Scholar 

  29. Caudle RJ, Stern PJ (1987) Severe open fractures of the tibia. J Bone Jt Surg 69A:801–807

    Google Scholar 

  30. Cole JD, Ansel LJ, Schwartzberg (1995) A sequential protocol for management of severe open tibial fractures. Clin Orthop Relat Res 315:84–103

  31. Bone LB, Kassman S, Stegemann P (1994) Prospective study of union rate of open tibial fractures treated with locked, unreamed intramedullary nails. J Orthop Trauma 8:45–49

    Article  CAS  PubMed  Google Scholar 

  32. Oh CW, Bae SY, Jung DY, Oh JK (2006) Treatment of open tibial shaft fractures using tightly fitted interlocking nailing. Int Orthop 30:333–337

    Article  PubMed  Google Scholar 

  33. Sinclair JS, McNally MA, Small JO, Yeates HA (1997) Primary free flap cover of open tibial fractures. Injury 28:581–587

    Article  CAS  PubMed  Google Scholar 

  34. Hertel R, Lambert SM, Muller S, Ballmer FT, Ganz R (1999) On the timing of soft-tissue reconstruction for open fractures of the lower leg. Arch Orthop Trauma Surg 119:7–12

    Article  CAS  PubMed  Google Scholar 

  35. Trabulsy PP, Kerley SM, Hoffman WY (1994) A prospective study of early soft tissue coverage of grade IIIB tibial fractures. J Trauma 36:661–668

    Article  CAS  PubMed  Google Scholar 

  36. Akin S, Durak K (2002) One-stage treatment of chronic osteomyelitis of the proximal tibia using a pedicle vascularised double-barrel fibular flap together with s muscle. Br J Plast Surg 55:520–523

    Article  CAS  PubMed  Google Scholar 

  37. Gopal S, Giannoudis PV, Murray A, Matthews SJ, Smith RM (2004) The functional outcome of severe open tibial fractures managed with early fixation and flap coverage. J Bone Jt Surg 86-B:861–867

    Article  Google Scholar 

  38. Lutz BS, Ng SH, Cabailor R, Lin CH, Weif C (1998) Value of routine angiography before traumatic lower-limb reconstruction with microvascular free tissue transplantation. J Trauma 44:682–686

    Article  CAS  PubMed  Google Scholar 

  39. Disa JJ, Cordeiro PG (1998) The current role of preoperative arteriography in free fibula flaps. Plast Reconstr Surg 102:1083–1088

    Article  CAS  PubMed  Google Scholar 

  40. Wiss D, Sherman R, Oechsel M (1993) External skeletal fixation and rectus abdominis free-tissue transfer in the management of severe open fractures of the tibia. Orthop Clin North Am 24:549–552

    CAS  PubMed  Google Scholar 

  41. Francel TJ, Vander Kolk CA, Hoopes JE, Manson PN, Yaremchuk MJ (1992) Mircovascular soft tissue transplantation for reconstruction of acute open tibial fractures: timing of coverage and long-term functional results. Plast Reconstr Surg 89:478–487

    Article  CAS  PubMed  Google Scholar 

Download references

Conflict of interest statement

The authors state that no benefits have been received from a commercial party related directly or indirectly to the subject of this article and they have no conflicts of interest to report.

Author information

Authors and Affiliations

  1. Department of Orthopedics, The General Hospital of PLA, Lanzhou, 333 Southern Binhe Road, Lanzhou, 730050, Gansu, People’s Republic of China

    Ping Zhen, Xing-Yan Liu, Hao Lu & Xu-Sheng Li

Authors
  1. Ping Zhen
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Xing-Yan Liu
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Hao Lu
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Xu-Sheng Li
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ping Zhen.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Zhen, P., Liu, XY., Lu, H. et al. Fixation and reconstruction of severe tibial shaft fractures with vascularized fibular grafting. Arch Orthop Trauma Surg 131, 93–99 (2011). https://doi.org/10.1007/s00402-010-1121-4

Download citation

  • Received:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00402-010-1121-4

Keywords

Search

Navigation