Comparison of internal bone transport and vascularized fibular grafting for femoral bone defects

Objective: To compare results between vascularized fibular grafting and internal bone transport for large bone defects of the femur. Design: Retrospective review of patients. Setting: University teaching hospitals. Patients: This study included 37 patients with femoral bone loss: 20 patients were treated with internal bone transport and seventeen patients were treated with vascularized fibular grafting. Main Outcome Measurements: The outcomes investigated were external fixation time, external fixation index, bone results (union, infection, deformity, leg length discrepancy), and functional results. Results: The mean amount of filled defect was 8.4 cm with internal bone transport and 8.9 cm with vascularized fibular grafting. The external fixation index was 1.4 months/cm with internal bone transport and 1 month/cm with vascularized fibular grafting. The bone results and functional results of the internal bone transport were excellent in 65% and 0%, good in 5% and 45%, fair in 5% and 40%, poor in 25% and 15%, respectively, whereas those of the vascularized fibular grafting were excellent in 35% and 0%, good in 25% and 47%, fair in 5% and 35%, and poor in 35% and 18%. Conclusion: With vascularized fibular grafting, careful monitoring of circulation and early intervention surgery is necessary to avoid vascular failure. With internal bone transport, repeated radical debridement until control of infection is achieved, bone grafting at the docking site for early union, and avoiding stress fracture are recommended to improve bone results.