Use Of Free Non Vascularized Fibular Intramedullary Strut Graft As Adjunct To Dynamic Compression Plate In Severe Atrophic Fracture Non Union In Young Adult

Background: Operative treatment of atrophic fracture non-union of a long bone with the use of a dynamic compression plate poses a serious challenge to orthopedic surgeons in developing countries due to the difficulty of ensuring firm purchase by the screw in the bone. Ilizarov fixator, locking plates and free vascularized fibular graft are viable options that may not be readily available due to cost and lack of expertise. 

Patients and Methods: We report the use of free fibular intramedullary strut graft to bridge the fracture site in order to enhance the pull-out strength of the screws of dynamic compression plate in the operative treatment of severe atrophic fracture non-union involving the femur and humerus in two young adults.

Result: The patients progressed to the successful union of the fractures at the last follow-up without recourse to additional iliac crest bone grafting.

Conclusion: Free fibular intramedullary strut graft as an adjunct to dynamic compression plating in severe atrophic fracture non-union of a long bone is a feasible, readily available, and helpful option, especially for surgeons in developing countries faced with this challenge.