Transarticular bony defects after trauma and sepsis: Arthrodesis using vascularized fibular transfer

Ten male patients with previously infected bony defects involving both side s of an articulation underwent arthrodesis using a vascularized fibular tra nsfer. The average age of these patients was 38 years (range, 20 to 60 year s). The size of the bony defect averaged 9 cm (range, 3 to 21 cm). The ankl e was involved in five patients, the knee in two patients, the wrist in two patients, and the elbow in one patient. Nine cases represented septic pseu darthroses (eight after trauma and one after attempted ankle arthrodesis). One patient had a defect across the wrist after debridement of a chronic in fection. The patients were followed for an average of 71 months (range, 26 to 144 months). Nine patients healed after the index vascularized fibular t ransfer, and one patient (ankle arthrodesis) required a second cancellous b one-grafting procedure for delayed union at the junction of the fibula with the talus. Four of seven patients with lower limb involvement had residual leg length discrepancies averaging 5 cm (range, 3 to 8 cm), and one had a persistent 20-degree internal rotation deformity. Two of the patients with upper limb involvement had stiff digits. Five of the nine previously employ ed patients returned to their former occupation (including heavy labor in f our cases). Complications included two wound separations, one case of insta bility of the donor ankle after removal of a large fibular graft (related i n part to a prier injury), and one fracture at the junction of the fibular graft with the local bone 10 months after the index procedure, which united after plate fixation and application of autogenous cancellous bone graft. Arthrodesis using a transfer of vascularized fibular bone represents a viab le option for limb salvage in the face of an infected transarticular bony d efect.