Chronic osteomyelitis. Use of ipsilateral fibular graft for diaphyseal defects of the tibia.

Acute haematogenous osteomyelitis is a major disease in this area, affecting 10% of the children seen in orthopaedic clinics. Few patients report early enough to benefit from antibiotic treatment, so the majority are seen quite late, usually in the chronic stage with discharging sinuses or chronic ulcers. In adults, chronic osteomyelitis results from inadequately treated open fractures. Injudicious sequestrectomy or very severe disease may lead to loss of length of the bone. A 5-year-old boy and a 30-year-old man suffered loss of length of tibia (averaging 8 cm). In an experimental work, a non-vascularised ipsilateral fibular graft was used to bridge the gaps in both tibiae, fixation was achieved with a tubular plate in one instance and an intramedullary rush nail in the other case. Both patients bore weight at 4 and 6 months, respectively. Amputation should therefore be avoided.