Vascularized versus nonvascularized free fibular grafts in reconstruction of post-traumatic critical long bone defects, a comparative study
Clinical Snapshot
PICO Framework
| P — Population | 50 patients with post-traumatic critical long bone defects >10 cm |
| I — Intervention | Free vascularized fibular graft (FVFG) |
| C — Comparator | Nonvascularized fibular graft (NVFG) |
| O — Outcomes | Time to union (primary), graft hypertrophy, functional scores (DASH/LEFS), complications, donor site morbidity |
Bottom Line
This randomized trial of 50 patients found no significant difference in union time between vascularized and nonvascularized fibular grafts for critical bone defects >10cm (5.78 vs 6.17 months, p=0.447). Both techniques achieved comparable functional outcomes and complication rates. The study suggests that nonvascularized grafts may be a viable, less complex alternative to vascularized grafts for selected patients. However, methodological limitations including unclear randomization methods, missing confidence intervals, and insufficient baseline data reporting limit confidence in these findings. The small difference in union time (11.7 days) is not clinically meaningful. Surgeons should consider patient factors, defect characteristics, and institutional expertise when choosing between techniques. Larger, more rigorously designed trials with longer follow-up are needed to definitively establish equivalence and guide clinical decision-making.
Key Findings
P Value: 0.447 (non-significant)
Effect Size: Mean difference 0.39 months (11.7 days) favoring FVFG
Primary Outcome: Time to union: FVFG 5.78 months vs NVFG 6.17 months
Nnt Or Sensitivity: Not applicable - no significant difference between treatments
Confidence Interval: Not reported
Clinical Application
Both techniques available in major Australian orthopedic centers with microsurgical capabilities Relevant to Australian trauma centers; NVFG may be preferred in resource-limited settings or when microsurgical expertise unavailable; both procedures likely covered under public hospital system Adult patients with post-traumatic critical long bone defects >10cm requiring reconstruction
Abstract
BACKGROUND: Reconstruction of critical-sized long bone defects is a complex orthopedic challenge. Free fibular grafts, vascularized (FVFG) and nonvascularized (NVFG), are established reconstructive options, but comparative clinical outcomes remain uncertain. PURPOSE: To compare clinical and radiological outcomes of FVFG and NVFG in patients with post-traumatic critical bone defects more than 10 cm. METHODS: A randomized controlled trial was conducted with 50 patients assigned equally to FVFG or NVFG groups. The primary outcome was time to union, while secondary outcomes included graft hypertrophy, functional scores (DASH and LEFS), complication rates, and donor site morbidity. RESULTS: The mean time to union was 5.78 months in the FVFG group and 6.17 months in the NVFG group, showing no statistically significant difference (p = 0.447). Rates of graft hypertrophy, functional recovery, and complications were comparable between the groups. CONCLUSIONS: Both FVFG and NVFG provide effective reconstruction for critical bone defects, with nearly similar healing times and functional outcomes. NVFG may represent a less complex alternative in selected cases.
References
- 1.Fouaad, A. A., Massoud, A. H., Shaban, M., Abdel-Naby, M., & Abulsoud, M. I. (2026). Vascularized versus nonvascularized free fibular grafts in reconstruction of post-traumatic critical long bone defects, a comparative study. Journal of Orthopaedics and Traumatology, Article 12605. https://doi.org/10.1097/MD.0000000000012605
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