Free vascularized fibular grafts have a high union rate in atrophic nonunions.

Free vascularized fibular grafting currently is an extremely useful tool in the armamentarium of the orthopaedic, reconstructive surgeon. Certain problematic nonunions, aseptic or infected, have to be treated by vascularized bone grafts when previous operations are not successful. The common characteristics of these nonunions are several previous operations and fixations, bone atrophy and damage of the surrounding soft tissue, and frequently focal, active infection. After the bone and soft tissue debridement, the bony defect is bridged by a vascularized fibula strut. Depending on the recipient bone, different methods of internal fixation can be used, usually plates and external fixators. Free vascularized fibular grafts in recalcitrant, atrophic nonunions provide a high success rate. According to the results, this is a safe, reliable method that is indicated when a fracture does not heal after several surgeries, when there is an associated bone lost, and when infection is present.