Intramedullary Fibula with Rigid Osteosynthesis in Revision of Neglected and Multiple times Operated Non Union of Long Bones

Abstract

Background: Plates with Intramedullary Fibula as Strut graft(IFSG) in Non- union of long bone fractures provides most stable construct overall as fibula acts as second implant, screws have better anchorage and very high pull out strength due to penetration of four cortices and osteogenic property of the fibula is most helpful. The aim of this paper is to re-focus the importance of non-vascularised intramedullary fibula as a second internal biologic stable splint along with rigid osteosynthesis for the treatment of difficult and neglected non -union of long bones. Methods and Material: 15 cases (13 :2,males: females) of revision surgery for the neglected and multiply operated non-union of the long bones were treated with the debridement, decortication and shingling of the fracture site with addition of the trimmed fibula (as intramedullary strut). Liberal cancellous bone graft was added subperiosteally with stable and rigid internal osteosynthesis by using LCP. DASH Score was used for upper limb and VAS for lower limb for assessment. Results: Union was achieved in all patients in 12 months (range 9-12 months). Preoperative DASH score averaged 40.86(range 42.6-52.6). DASH score at the last follow-up averaged 20.38 points (range 16.4-24.2).difference was significant. (p=0.0001) Conclusions: Intra medullary fibula almost works mimicking double plate and adds in the stability as it works as second plate. Its osteogenic property helps in the healing, not only at the fracture site but proximal and distal to it. This prevents slow union at the ends of bone which are usually avascular because of the lysis. Screws have a better hold around osteoporotic bones due to four cortices hold in presence of fibula. Strong bony union can be successfully achieved in almost all cases with rigid compression at the fracture site & additional extensive cancellous bone grafting. Keywords: Intra- medullary Fibula ,revision non union, rigid osteosynthesis.

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