Non-vascularized fibular autograft is a reliable option for reconstruction after tumor-related metatarsal resections

Objective: This study aimed to evaluate the clinical, radiological, and functional outcomes of metatarsal reconstruction using non vascularized fibular autografts after resection of benign aggressive and malignant tumors.

Methods: This retrospective review included 12 patients (15 reconstructions; 7 male, 5 female) who underwent metatarsal reconstruction with a non-vascularized fibular autograft between 2006 and 2023. The mean age was 27.6 Å} 9.3 years (range, 7-49), and the mean follow-up was 46.3 Å} 16.1 months (range, 29-157). Radiographic union at the proximal and distal graft–host junctions, complications classified according to the Henderson system, time to weight-bearing, time to Kirschner wire removal, and functional outcomes (Visual Analog Scale, Musculoskeletal Tumor Society (MSTS), Foot and Ankle Disability Index (FADI), and American Orthopaedic Foot and Ankle Society (AOFAS)) were evaluated.

Results: Radiographic union was achieved in all reconstructions without nonunion or graft failure. Mean union time was 7.1 Å} 1.1 weeks (range, 6-9) proximally and 10.1 Å} 0.8 weeks (range, 9-11) distally, and weight-bearing was initiated at a mean of 4.7 Å} 1.4 weeks (range, 3-8). Intercalary reconstruction yielded significantly higher functional scores than arthrodesis-based reconstruction (FADI, P = .012; AOFAS, P = .022; MSTS, P = .005) and shorter operative duration (P < .001). No local recurrence or systemic metastasis was observed during follow-up. Six patients developed soft-tissue complications (Henderson Type 1A/1B), none requiring amputation or revision surgery.

Conclusion: Non-vascularized fibular autograft reconstruction provided consistent union and generally favorable functional outcomes after tumor-related metatarsal resections in this series. Clinically, non-vascularized fibular autografts may represent a reliable, technically simpler alternative to vascularized grafts for metatarsal reconstruction and may reduce operative time and procedural complexity, with a relatively low rate of major complications.

Cite this article as: Aycan OE, Tuncer S, Doğan B, Polat B, Iğde N. Non-vascularized fibular autograft is a reliable option for reconstruction after tumor-related metatarsal resections. Acta Orthop Traumatol Turc., 2026; 60(3), 0540, doi: 10.5152/j.aott.2026.25540.