Vascularized Fibula Flap Onlay for Salvage of Pathologic Fracture of the Long Bones
Bibliographic record
Abstract
BACKGROUND: Long bone pathologic fractures, especially when radiation-induced, represent a significant and difficult-to-treat entity. The ultimate goal of treatment is limb salvage; however, there are no treatment methods that guarantee bony healing. The vascularized fibula flap has revolutionized bone reconstruction, including that of the long bones. The authors report the results of onlay vascularized fibula flaps for pathologic long bone fractures and the outcomes and complications of this reconstruction method. METHODS: Records of patients who underwent long bone pathologic fracture reconstruction with the vascularized fibula onlay flap were reviewed retrospectively. Records were analyzed for reconstruction details, time to bony union, subsequent operations, clinical and functional outcomes, and complications associated with harvest and reconstruction. RESULTS: Twenty-five patients met the study criteria. Twenty-one patients demonstrated bony fracture union at an average of 11 months after fibular flap onlay grafting. Two patients who had experienced bony union ultimately required amputations for reasons unrelated to reconstruction. All four patients whose fibular flap failed later obtained limb salvage after further procedures. Thirteen of 25 patients achieved a good or excellent functional outcome as judged by a common oncologic reconstruction functional outcome scale. Postsurgical complications were common in this patient group, with a total of 22 distinct complications (88 percent incidence). CONCLUSIONS: Despite a high complication rate, this study demonstrates that pathologic long bone fracture salvage with an onlay fibula flap achieves relatively good clinical and functional outcomes. Limb salvage was made possible in a majority of patients, all of whom experienced a difficult problem in the form of long bone pathologic fractures.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".