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As the procedure is relatively rare, there is no universal agreement on the management and outcome. This systematic review aimed to first, identify the conditions for which FVFG has been applied; second, to gain an understanding of the surgical techniques used; and third, to report outcomes related to bone union, infection eradication, function and complications. A PRISMA strategy was used. Medline, Cochrane Central Register of Controlled Trials, Scopus and EMBASE library databases were interrogated using pre-defined MeSH terms and Boolean operators. Quality of evidence was evaluated based on OCEBM and GRADE systems. Fourteen studies based on 37 patients were identified with a mean follow-up time of 33.3\u00a0months. The most common reasons for the procedure were: fracture non-union; tumours requiring resection; post-radiation treatment osteonecrosis and osteomyelitis. The operation approaches were similar, involving graft retrieval, insertion and fixation and vessels chosen for reattachment. The mean clavicular bone defect size was 6.6\u00a0cm (\u00b1\u20091.5), prior to FVFG. Bone union occurred in 94.6% with good functional outcomes. Complete infection eradication occurred in those with preceding osteomyelitis. The main complications were broken metalwork, delayed union\/non-union and fibular leg paraesthesia (n\u2009=\u200920). The mean re-operation number was 1.6 (range 0\u20135.0). The study demonstrates that FVFG is well tolerated and has a high success rate. However, patients should be advised about complication development and re-intervention requirement. Interestingly, overall data is sparse with no large cohort groups or randomised trials.<\/jats:p>","DOI":"10.1007\/s00590-023-03598-8","type":"journal-article","created":{"date-parts":[[2023,6,8]],"date-time":"2023-06-08T14:02:34Z","timestamp":1686232954000},"page":"3307-3318","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Clavicular bone defects managed with free vascularised fibular grafting: evidence to date"],"prefix":"10.1007","volume":"33","author":[{"given":"Sophia M.","family":"Wakefield","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vasileios P.","family":"Giannoudis","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter V.","family":"Giannoudis","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2023,6,8]]},"reference":[{"key":"3598_CR1","doi-asserted-by":"publisher","first-page":"333","DOI":"10.1016\/j.jse.2012.02.006","volume":"22","author":"N Matsumura","year":"2013","unstructured":"Matsumura N, Nakamichi N, Ikegami H, Nagura T, Imanishi N, Aiso S, Toyama Y (2013) The function of the clavicle on scapular motion: a cadaveric study. 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The authors have no conflict of interest to declare that are relevant to the content of this article. All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest or non-financial interest in the subject matter or materials discussed in this manuscript. The authors have no financial or proprietary interests in any material discussed in this article.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}}]}}