Dolph Houben

61 Combined massive allograft and intramedullary vascularized fibula 3 [7] . This study described results in a series of trauma cases (n=6). The evidence in all studies was level IV, except for the study of Manfrini et al. [25] which was a case-control (level IIIb). This case- control study compared the combination of a massive allograft and centralized (pedicled) fibula flap, with use of a massive allograft and a free vascularized fibula flap. In our review, we included both techniques. A summary of all the study characteristics is shown in Table 1. Table 1: Study characteristics Author Study design Operation period N Gender Age in years (range) Mean Follow-up (months) Pathology Yang et al. ,2010 Case series 2001-2005 17 7F/10M 18,4 (6-34) 20.2 oncologic Weichman et al. ,2015 Case series 2003-2011 12 7F/5M 15,8 (3-49) 41.4 oncologic Venkatramani et al. ,2015 Case series 2012- 2013 6 6M 33 (18-49) 15 trauma Rabitsch et al. , 2013 Case series unknown 12 8F/4M 17,8 (11-31) 38.7 oncologic Ozaki et al. ,1997 Case series 1991-1993 12 5F/7M 14 (7-54) 32 oncologic Moran et al. ,2006 Case series 1997-2002 7 2F/5M 10,5 (5-18) 52 oncologic Manfrini et al. , 1999 Case series 1989-1996 10 unknown 10,8 (7-12) 64 oncologic Manfrini et al. , 2017 Case control 1994-2013 47 14F/33M 14,6 (6-38) 84 oncologic Li et al. ,2010 Case series 2003-2008 11 6F/5M 18,5 (11-32) 34.1 oncologic Li et al. , 2015 Case series 200-2011 11 5F/6M 12 (9-16) 48 oncologic Jager et al. ,2010 Case series 2003-2010 7 1F/6M 16,5 (8,5-17) 44.1 oncologic Innocenti et al. ,2009 Case series 1988 -2006 21 8F/13M 18,1 (5-52) 139.3 oncologic Houdek et al. ,2016 Case series 1997-2012 18 9F/9M 11 (5-18) 96 oncologic Halim et al. ,2015 Case series 1999-2012 10 unknown 19,8 (5-44) 63 oncologic Erol et al. ,2015 Case series 2005-2012 7 3F/4M 10,4 (4-15) 38,9 oncologic Ceruso et al. ,2008 Case series 1994-2007 31 unknown 14 (4-31) 75 oncologic Capanna et al. ,2007 Case series 1988-2002 90 unmown unknown 108 oncologic Reconstruction methods A total of 236 cases of tibial reconstruction and 93 femoral reconstructions are published in the included 17 articles. Six articles presented only tibial reconstructions and one study presented only femoral reconstructions. In 52 cases a pedicled fibula graft was used and in 277 cases a free vascularized fibular graft was used, both in combination with a massive allograft. In all studies plate fixation, interfragmentary screws, K-wires or a combination was used for fixation. Both minimal fixation methods and extensive internal fixation methods have been reported. Minimal fixation methods such as small fragment screws combined with a plate and more ridged fixation methods as large plates spanning the entire defect and even dual-plating. See Table 2 for a detailed summary of the used reconstruction methods and flap monitoring details per study.