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PubMedDate not supplied

[Primary osteotomy of the fibula in the treatment of post-traumatic tibial pseudoarthrosis].

In a retrospective study 32 case histories of patients with primary osteotomies of the fibula were evaluated to find out the reliability of this method in the treatment of tibial pseudarthroses. The influence of the osteotomy level and extent was taken into account as well. In 23 cases the pseudarthroses resulted from tibial and fibular fractures. Causative for the pseudarthroses were the blocking effects of healed fibula, tibial infection and loose osteosynthetic materials. 22 tibial pseudoarthroses healed by fibular osteotomy and postoperative immobilisation only, healing time was 25 months on average, in case of proximal fibular osteotomies even longer. The extent of fibular resection was between 5 and 30 mm. In contrast to "modern" methods of treatment, primary osteotomies in the treatment of tibial pseudarthroses take a rather long time to heal.

Adult↗
PubMed1998

Free combined anterolateral thigh flap and vascularized fibula for wide, through-and-through oromandibular defects.

Through-and-through oromandibular defects require the greatest amount of soft-tissue volume among the transfers for head and neck defects. A new method, a large anterolateral thigh flap combined with a vascularized fibula graft in a chimera fashion, has been used for two patients with wide through-and-through oromandibular defects. Among the candidates for such a large skin flap, the anterolateral thigh flap seems to be the best, for the following reasons. (1) Its pedicle, the lateral circumflex femoral system, has several major branches of equal size of anastomosis of the peroneal vessels. (2) As the majority of such patients with multiple previous surgery have lost recipient vessels near the mandible, the longest vascular pedicle is required. (3) There is no need for positional changes, and simultaneous flap elevation with the tumor resectioning is possible. (4) Use of the fibula allows for reconstruction of the entire mandible, if necessary. (5) Some of the shortcomings of individual donor sites for massive composite osteocutaneous flaps are minimized, because each component consists of two donor sites. (6) Operating time for this flap elevation is minimized, compared to that for massive composite osteocutaneous flaps, because the individual components can be obtained simultaneously by two teams.

Aged↗
PubMedDate not supplied

[In vitro studies of the load bearing function of the interosseous membrane and fibula in relation to total stress capacity of the lower leg].

The present paper illustrates the importance of the interosseous membrane and the loadbearing function of the fibula in relieving stress on the tibia. The author's theoretical and experimental studies, as well as clinical observations, confirm that the intact interosseous membrane and fibula relieve the tibia by approx. 30%.

Adolescent↗
PubMed1988

Reconstruction of bone and soft tissue defects with free fibula transfer.

More and more it is recognized that for the reconstruction of extensive long-bone defects, especially in combination with soft tissue loss, revascularized bone transfers are preferable. For the reconstruction of larger bony defects, revascularized crista iliaca bone or fibula bone are the first choice. The fibula has certain advantages over the crista: It is a straight cortical bone, the length is almost always sufficient to reconstruct large defects, and soft tissue reconstruction is possible by including a skin island. A short description of the operation technique, pitfalls, and indications are given.

Bone Cysts↗
PubMed1990

Ankle instability of the donor site following removal of vascularized fibula bone graft.

We have assessed the donor site of fibula bone graft to detect signs and symptoms of ankle instability in 8 patients. In 1 patient with generalized joint hyperlaxity pain, clinical instability and pathological motion of the proximal end of the distal remaining fibula were encountered. Seven other patients were asymptomatic and had no instability both clinically and on stress radiographs.

Adult↗
PubMedDate not supplied

Congenital pseudarthrosis of the tibia: successful one stage transposition of the fibula into the distal tibia. A case report.

An infant male presented at age 17 months with an established pseudarthrosis in a kyphoscoliotic right tibia. During the ensuing 6 years, three unsuccessful McFarland bypass bone grafts were performed. Then the distal end of the proximal fibula was placed into the medullary cavity of the proximal end of the distal tibia without disturbing the proximal portion of the fibula. This was augmented by autogenous bone graft. Union occurred in one year. The child has been followed for 7 years and the pseudarthrosis remains healed.

Bone Diseases↗
PubMedDate not supplied

An irreducible distal fibula dislocation while in-line skating.

We present a case report of a variation of a Bosworth fracture, which is a posterior dislocation of the proximal fragment of a distal fibula fracture. Our patient had a distal fibula dislocation without fracture. He was treated with an open reduction and internal fixation using syndesmotic screws. At his most recent follow-up, he was ambulating without pain.

Adolescent↗
PubMed1977

Irreducible fracture dislocation of the ankle due to posterior dislocation of the fibula.

In order to prevent permanent disability, a proper diagnosis of the fixed posterior fracture dislocation of the fibula with fracture dislocation of the ankle joint must be made. Full-length (knee to ankle) radiographs are necessary to make this diagnosis. Although a closed reduction has been described as successful, we feel that an open reduction is usually necessary. Freeing of the trapped fibula from behind the tibia results in a satisfactory reduction of this fracture dislocation. The reduction and fixation of the malleolar fragment is then simple, and an excellent result can be expected.

Adult↗
PubMed1983

Fracture-dislocation of the ankle with anterior dislocation of the fibula.

A fracture-dislocation of the ankle with fixed anterior displacement of the proximal fibular fragment is reported. The mechanism of this injury was likely eversion of the foot which produced rupture of the deltoid ligament and distal tibiofibular diastasis, and lateral dislocation of the talus. The proximal fibular fragment was probably displaced laterally and returned to a position anterior to the fibular notch of the tibia. This injury was extremely unstable and required open reduction with internal fixation, not only to reduce the anterior displacement of the fibula but also to repair the associated disruption of the syndesmotic ligament and anterior capsule. The key radiographic finding was anterior displacement of the distal fibula seen on the lateral view.

Ankle Injuries↗
PubMed1997

Free fibula osteoseptocutaneous graft for reconstruction of segmental femoral shaft defects.

Seventeen major reconstructions of the femoral shaft using vascularized fibula osteoseptocutaneous grafts were performed from August 1984 to September 1993. Patients were 14 males and 3 females, with an average age of 34 years. All patients had sustained high-energy trauma in motor vehicle crashes and had bone defects averaging 10 cm. The skeletal defect was primary attributable to bone loss at the time of injury (2 cases) or secondary after infection and sequestrectomy (15 cases). Vascularized fibular transfer was performed at an average of 6 months after trauma. The fibular graft was inserted as a single strut in 10 cases and as a double-barrel composite in 7 cases. Patients were evaluated at an average of 43 months after surgery. All grafts eventually united, and no patient showed evidence of recurrent or persistent infection. The average time to radiologic union was 8 months, and the average time to full weight bearing was 14 months. Secondary bone grafting and internal fixation were required in five cases because of delayed union, stress fracture, or screw loosening. All cases of delayed union and stress fracture were in those reconstructed by single-strut fibular graft. Four cases (24%) required quadriceps plasty and arthrolysis. The final average arc of active knee motion was from 0 to 80 degrees. Limb length discrepancy ranged from 0 to 7 cm (average, 3 cm). Five cases (29%) had varus deformity averaging 30 degrees. The fibular graft hypertrophied to 100% of the femoral circumference in cases followed for 3 years. Donor site morbidity was negligible. At the time of final follow-up, 13 patients had returned to their original jobs, two were permanently disabled because of below-knee amputation, and two were retired. The study suggests that vascularized fibula osteoseptocutaneous transfer is a valuable procedure for reconstruction of large, previously infected femoral shaft defects.

Adolescent↗
PubMed1997

Reconstructed mandibular defects: fibula free flaps and osseointegrated implants.

Twenty patients with microvascular fibula flap reconstruction of oromandibular defects were selected for implant-retained prosthodontic rehabilitation. A total of 71 osseointegrated implants were placed within the grafted fibulas. Four patients had immediate implant placement at the time of their reconstructive surgery, and the remaining 16 patients had implants placed secondarily. One patient received postoperative radiation therapy (5910 cGy) 6 weeks following reconstruction and immediate implant placement. No implants were placed in previously irradiated flaps. A minimum 6-month period of osseointegration was allowed prior to second stage surgery. Fifty-four of the 71 implants were uncovered; 46 of these implants were functional, and 3 were in the process of being restored. Among the 54 implants (15 patients) that were uncovered, only 1 failed to osseointegrate, 2 implants were reburied, and 2 were removed. The follow-up period ranged from 1 to 49 months since second stage surgery. Although a number of prosthodontic designs were used, 11 of the 15 patients were restored with removable overlay prostheses. Only those implants exposed to postoperative radiation demonstrated radiographic bone loss following functional loading.

Adult↗
PubMed1999

Reliability of the proximal skin paddle of the osteocutaneous free fibula flap: a prospective clinical study.

The vascularization of the skin paddle of 20 osteocutaneous fibula free flaps in 20 patients was studied. All skin paddles were designed over the proximal and middle third of the fibula. A parallel vascularization of the skin was found in 10 cases. In these cases, an axial (septo)musculocutaneous perforator was found to originate high in the peroneal artery or even in the popliteal artery. This branch runs parallel to the peroneal artery without any further connections with it. In 5 of these 10 cases, no other skin perforators were located within the boundaries of the skin paddle. Harvesting such a flap in the traditional way by blind inclusion of a muscle cuff results in ligation of the supplying vessel of the skin paddle and subsequent loss of the skin. In this series, this would have been the case in 5 of the 20 patients (25 percent). This might explain the bad reputation of the skin paddle of this flap. The high prevalence of the described vascular configuration in a proximally designed skin paddle justifies à vue dissection of all musculocutaneous perforators up to their origin, unless one or more septocutaneous perforators are found within the boundaries of the flap.

Fibula↗
PubMed2002

Long-term fate of the bony component in neophallus construction with free osteofasciocutaneous forearm or fibula flap in 18 female-to-male transsexuals.

Female-to-male transsexuals have been operated on in the authors' department since 1975. Between 1981 and 1995, 46 patients underwent neophallus construction with a free osteofasciocutaneous forearm or fibula flap. The bony part of these flaps is embedded in tissue with excellent blood circulation, has no contact with the skeleton, and is free of mechanical stress. To evaluate the long-term fate of the bony component of these flaps, the authors examined 18 of the 46 patients (39.1 percent) who had received a neophallus by means of one of these methods (12 with forearm and six with fibula flap) and who were willing to participate in the updating of the results of the previous two decades; this represented a follow-up of 5 to 112 months postoperatively (average, 27.4 months). The following investigations were undertaken: clinical and radiologic examination, bone scintigraphy, magnetic resonance imaging, and histologic examination of the neophallus bony component. In all patients, the clinical examination showed no significant variations in the shape and rigidity of the neophallus bone. The radiologic examination showed a compact bone structure, and the magnetic resonance imaging proved the vitality of the neophallus in all patients, with no significant changes over time. Bone scintigraphy did not prove to be useful in determining the long-term fate of the neophallic bony component. Histologically, subperiosteal neoformation of fibrous bone was shown, whereas the lamellar cortical bone was predominantly avital. The results of this study reveal the vitality of the bony component in neophallus construction with free osteofasciocutaneous flaps. Even 112 months after the procedure, it provided sufficient stiffness for sexual intercourse. This continuing adequate rigidity of the bony component, in addition to the well-known advantages of the free osteofasciocutaneous flap, is further evidence of its usefulness in neophallus construction.

Female↗
PubMed1995

Reconstruction of the head and neck cancer patient with a vascularized fibula flap and dental implants: preliminary clinical report.

Reconstruction and rehabilitation of the head and neck cancer patient is challenging. Vascularized fibula grafts can be used to reconstruct mandibular defects after resection of the malignancy and the surrounding bone. Prosthodontic treatment can restore function and esthetics. This preliminary report discusses the use of endosseous implants in radiated mandibular vascularized fibula grafts after surgical resection.

Bone Transplantation↗
PubMed2002

Isolated congenital pseudoarthrosis of the fibula.

Congenital pseudarthrosis of the limb most commonly involves the tibia, although various combinations of bones including fibula, radius, ulna, clavicle and humerus have all been described. Isolated congenital pseudarthrosis of the fibula is a very rare entity with only 12 cases reported in the English literature. We report three cases of this condition treated in our institution. The first child had a varus ankle deformity at the age of 4 months. The other two children presented with valgus ankle deformity after they started to walk. Two patients were treated conservatively while the third had a distal tibio-fibular fusion in view of severe valgus deformity. All three patients showed good early results after 1 to 2 years. We advocate early distal tibio-fibular fusion to prevent valgus deformity in these children.

Arthrodesis↗
PubMed2002

Tibial lengthening: does the fibula migrate?

A retrospective study of 32 patients who underwent tibial lengthening was performed in order to establish the need for distal tibio-fibular fixation. In 16 patients stabilization of the inferior tibio-fibular joint was carried out and in the other 16 no stabilization was performed. Three established and one new radiographic index of the tibio-fibular relationship at the ankle were used to assess proximal fibular migration. All patients showed proximal migration of the distal fibula, but those without stabilization demonstrated marked migration of the fibula associated with a valgus tendency. The difference between the groups was statistically significant ( <0.001), confirming the need for fibular fixation.

Adolescent↗
PubMed2004

Findings of fibular hemimelia syndrome with radiographically normal fibulae.

We have noted a number of patients with features of fibular hemimelia with radiographically normal fibulae. This study was undertaken to further define this group. A review of hospital records and radiographs over a 72-year period identified 149 limbs in 123 patients with features of fibular hemimelia syndrome. Sixteen limbs in fourteen patients had findings of fibular hemimelia with radiographically normal fibulae. Thirteen of 16 had absent lateral rays with either ball and socket ankle joint, tarsal coalition or both. Six of the 13 had limb shortening. Three limbs in three patients did not have absent lateral rays, but had at least two other features of fibular hemimelia syndrome. All of these three limbs had ball and socket ankles and tarsal coalitions and two had shortening. These patients represent a mild subset of fibular hemimelia syndrome and we propose that they be classified as type 0 fibular hemimelia.

Ankle Joint↗