Long-term outcomes of vascularized fibular grafting for infected non-union of the lower limb: a competing-risk analysis
Abstract
Background: Infected non-union of the lower limb is among the most challenging conditions in orthopedic surgery. Vascularized fibular grafting (VFG) is a limb-salvage option for large infected bone defects, but outcomes accounting for competing events remain poorly documented. Methods: We conducted a retrospective single-center study of adults treated consecutively with VFG for infected femoral or tibial non-union between 2014 and 2023. Infected non-union combined institutional non-union criteria with fracture-related infection as per international consensus definitions. Treatment success was defined as consolidation with infection remission. Amputation and death were competing events; cumulative incidence of consolidation was estimated using competing-risk methods. Results: A total of 22 patients were included (median age of 45 years). Consolidation was achieved in 17 patients (77 %), infection remission was achieved in 16 (73 %), and treatment success was achieved in 16 (73 %): 9 (41 %) after VFG alone and 7 (32 %) after secondary bone grafting. Six patients (27 %) had unfavorable outcomes: four amputations, one persistent non-union, and one death. The median time to consolidation was 14 months after VFG alone and 38 months after secondary grafting. Cumulative incidence of consolidation reached approximately 18 % at 12 months, 41 % at 24 months, 59 % at 36 months, and 76 % by end of follow-up. All seven patients undergoing secondary grafting for delayed consolidation ultimately achieved union; no formal comparative analysis was performed given the small, time-dependent sample. Conclusion: VFG is a valuable limb-salvage strategy for selected patients with infected non-union. Consolidation may occur late, underscoring the need for prolonged follow-up and competing-risk methodology. Findings should be interpreted given the retrospective design, small sample, and heterogeneous follow-up.
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BibTeX
@article{hir2026longterm,
title = {{Long-term outcomes of vascularized fibular grafting for infected non-union of the lower limb: a competing-risk analysis}},
author = {Anne Le Hir and Piseth Seng and David Delarbre and Romain Ambrosino and Najib Kachouh and Régis Legré and Andreas Stein},
journal = {Journal of Bone and Joint Infection},
year = {2026},
month = sep,
doi = {10.5194/jbji-11-579-2026},
url = {https://amu.hal.science/hal-05836687v1},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Long-term outcomes of vascularized fibular grafting for infected non-union of the lower limb: a competing-risk analysis
AU - Anne Le Hir
AU - Piseth Seng
AU - David Delarbre
AU - Romain Ambrosino
AU - Najib Kachouh
AU - Régis Legré
AU - Andreas Stein
PY - 2026
DA - 2026/09/15
JO - Journal of Bone and Joint Infection
DO - 10.5194/jbji-11-579-2026
UR - https://amu.hal.science/hal-05836687v1
AB - Background: Infected non-union of the lower limb is among the most challenging conditions in orthopedic surgery. Vascularized fibular grafting (VFG) is a limb-salvage option for large infected bone defects, but outcomes accounting for competing events remain poorly documented. Methods: We conducted a retrospective single-center study of adults treated consecutively with VFG for infected femoral or tibial non-union between 2014 and 2023. Infected non-union combined institutional non-union criteria with fracture-related infection as per international consensus definitions. Treatment success was defined as consolidation with infection remission. Amputation and death were competing events; cumulative incidence of consolidation was estimated using competing-risk methods. Results: A total of 22 patients were included (median age of 45 years). Consolidation was achieved in 17 patients (77 %), infection remission was achieved in 16 (73 %), and treatment success was achieved in 16 (73 %): 9 (41 %) after VFG alone and 7 (32 %) after secondary bone grafting. Six patients (27 %) had unfavorable outcomes: four amputations, one persistent non-union, and one death. The median time to consolidation was 14 months after VFG alone and 38 months after secondary grafting. Cumulative incidence of consolidation reached approximately 18 % at 12 months, 41 % at 24 months, 59 % at 36 months, and 76 % by end of follow-up. All seven patients undergoing secondary grafting for delayed consolidation ultimately achieved union; no formal comparative analysis was performed given the small, time-dependent sample. Conclusion: VFG is a valuable limb-salvage strategy for selected patients with infected non-union. Consolidation may occur late, underscoring the need for prolonged follow-up and competing-risk methodology. Findings should be interpreted given the retrospective design, small sample, and heterogeneous follow-up.
SN - 2206-3552
ER -