One-stage treatment of infected nonunion of the distal tibia with reverse-flow vascular pedicle fibular grafts

Objective To measure the effect of one-stage transplantation of reverse-flow vascular pedicle fibular grafts in treatment of infected nonunion of the distal tibia. Methods From January 2001 to December 2012, 23 patients sustaining the infected nonunion of the distal tibia were transplanted with reverse-flow vascular pedicled fibular grafts in one-stage. There were 13 males and 10 females, aged 26 to 59 years (mean, 38.7 years). Tibial nounion based on the Jain-Sinha classification was rated as Type A in 6 patients and Type B in 17 patients. After the operation, the patients received 2-3 weeks of intravenous antibiotic treatment and then 4-week oral antibiotic therapy. Wound healing, limb and ankle joint fucntion and outcomes in fibular transplantation were observed. Results Duration of follow-up was 16-46 months (mean, 28.6 months). There were no exudates and ulcerations of the skins. Smooth healing was achieved in all the patients except that fibular fracture was noted in one patient healed after cast immobilization. Healing time ranged from 12 to 28 weeks (mean, 15. 6 weeks). Limb function evaluated with Ennecking system had (87±11)% restoration. According the Olerud-Molander scoring system, ankle function was excellent in 16 patients and good in 7 patients, with the excellent-good rate of 100%. Conclusion One-stage reverse-flow vascular pedicle fibular grafting is an optional procedure for treatment of infected nonunion of the distal tibia, due to the technique is easy and effective. Key words: Infection; Tibia; Bone transplantation