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PubMed1995

Clawtoe deformity following vascularized fibula graft.

The free vascularized fibula graft has been an increasingly useful tool in orthopaedic surgery. In addition to its many applications, the reported low donor site morbidity has helped make this a popular treatment modality. Isolated flexor hallucis longus flexion contracture has been reported in the literature; however, multiple ipsilateral clawtoe deformity has not been reported. We describe two cases of multiple clawtoe deformity following ipsilateral harvest of a free vascularized fibula graft.

Adult↗
PubMed1979

Congenital deficiency of the fibula.

Ninety-seven limbs, in eighty-one patients, with a diagnosis of congenital deficiency of the fibula have been reviewed. A classification was devised to distinguish the minimal hypoplasia of the fibula (Type I) from the well-known complete absence (Type II). Congenital anomalies of the femur were present in 76 per cent of patients with Type I deficiency and in 59 per cent with Type II. The shortening of the limb was by 13 per cent in Type I and by 19 per cent in Type II, and the percentage shortening was fairly constant during growth. A detailed description of the spectrum of other congenital anomalies was found to be characteristic: for example, the ball and socket formation of the ankle, tarsal coalition and anomalies of the foot. The treatment aimed simply to equalise leg length in Type I deficiency, while amputation of the foot and the fitting of a prosthesis were necessary in Type II to obtain satisfactory function.

Amputation, Surgical↗
PubMed1981

Vascular pedicle graft of the ipsilateral fibula for non-union of the tibia with a large defect. An experimental and clinical study.

Failure of union of the tibia with a large defect is difficult to treat, especially in the presence of sepsis and adherent scars. Conventional methods of fixation and bone grafting are not easily applicable. Experiments on Macaca monkeys showed that a vascularised pedicle graft of the shaft of the ipsilateral fibula could be fixed across a defect in the tibia and remain viable, even if it was isolated from surrounding soft tissues. Transfer of part of the shaft of the ipsilateral fibula on a vascular and muscle pedicle was carried out in 11 patients with large tibial defects and sepsis. There was one failure because of severe infection, but the other 10 patients gained sound union in about four months. The tibia was then protected by a caliper for the 18 months of full reconstitution. The bone infection healed and there was no evidence of avascular necrosis. Although the salvaged limbs were scarred, stiff and ugly, none of the patients suffered from pain, recurrent oedema or persistent infection.

Adolescent↗
PubMed1990

Donor site morbidity following resection of the fibula.

Ten adults were studied two to seven years after resection of a fibula for use as a free vascularised bone graft. Six had no symptoms in the donor leg, four had some aching, weakness or paraesthesia and three had definite weakness of the long toe flexors and extensors. All knees and ankles were clinically and radiologically stable, but the distal fibular remnant was osteoporotic in nine patients. Gait analysis of the donor leg and the contralateral normal leg showed definite differences, which could be attributed to weakness of the deep muscles caused by loss of their normal origin and to the change in load transmission through the fibula.

Adult↗
PubMed2004

Weakness of extensor hallucis longus after removal of non-vascularised fibula as an autograft.

The upper three-quarters of the fibula is commonly used as a non-vascularised autograft. Subsequent to this isolated weakness of extensor hallucis longus may occur. We have studied 26 patients in whom the upper and middle thirds of the fibula had been harvested as a graft through Henry's posterolateral approach. Isolated weakness of extensor hallucis longus was found after operation in ten patients but not in the remainder. EMG and nerve-conduction studies confirmed injury of the nerve to extensor hallucis longus in those with weakness. We dissected 40 cadaver limbs and found that those in which the nerve to extensor hallucis longus ran close to the fibular periosteum were at risk. The injury is mostly incomplete and recovery occurs within four to six months.

Adult↗
PubMed2003

Avulsion fracture of the head of the fibula (the "arcuate" sign): MR imaging findings predictive of injuries to the posterolateral ligaments and posterior cruciate ligament.

OBJECTIVE: The purpose of this study was to describe the significance of an avulsion fracture of the head of the fibula ("arcuate" sign) and its association with injuries of the knee on MR imaging. MATERIALS AND METHODS: We conducted a retrospective search of 2318 patients who underwent conventional radiography and MR imaging after an episode of knee trauma. Patients were included in this study if they had an avulsion fracture of the head of the fibula revealed on conventional radiography and underwent arthroscopy. Thirteen patients, all of whom were men, satisfied the inclusion criteria. Ten patients underwent further explorative surgery. The clinical, radiographic, MR imaging, and surgical findings were then reviewed. RESULTS: The avulsion fracture of the styloid process of the fibular head was apparently related to injuries of the arcuate complex in all 13 patients. Radiographically, the bony fragment was horizontally oriented and similar in size in most patients, ranging from 8 to 10 mm in length and from 2 to 5 mm in width. On MR imaging, the fibular avulsion was identified in 11 of the 13 patients. The other two patients had marrow edema in the fibular styloid process, although the avulsion fracture was not evident. All patients had injuries of the posterior cruciate ligament (six tibial avulsions, seven midsubstance tears). No patient had a tear of the anterior cruciate ligament. Disruption of the lateral collateral ligament was evident in seven patients, and one patient had a tear of the popliteal tendon. During surgery, six patients had disruption of the arcuate complex, but this disruption could not be identified on the MR images. CONCLUSION: An avulsion fracture of the fibular head generally involves the styloid process and causes injury of some of the major stabilizers in the posterolateral corner. Avulsion fractures are strongly associated with disruption of the posterior cruciate ligament.

Adolescent↗
PubMed2000

Single-incision technique for internal fixation of distal tibia and fibula fractures.

Open reduction and internal fixation of distal tibia and fibula fractures generally involves two separate incisions: an anteromedial incision to approach the tibia and a lateral incision to approach the fibula. Exposing the distal tibia from the medial side is associated with the risk of wound dehiscence, infection, and discomfort to the patient since the hardware is directly beneath the skin. By using a single incision from the anterolateral side, the fibular fracture can be fixed and the lateral aspect of the distal tibia can be safely approached for internal fixation, thus eliminating the need for two separate incisions.

Female↗
PubMed1985

Bilateral fatigue fractures of the distal fibulae caused by a change of running shoes.

A 26-year-old man sustained bilateral, symmetrical fatigue fractures of his distal fibulae while running in a 14-km road race. He had trained repeatedly over the course without developing any symptoms, but on the day of the race he lost one of his regular running shoes. He competed instead in old, borrowed tennis shoes. After running over a distance of 2 km, he felt pain about 4 cm above the distal end of both fibulae. Two weeks later, radiographs showed bilateral fractures. The change of footwear was the only identifiable factor in the causation of these fractures. Analysis by compression-loading showed that his usual running shoes absorbed twice as much energy and deformed five times as much as those used in the race.

Adult↗
PubMed1998

[Congenital posterior and posteromedial bowing of the tibia and fibula].

Five children with congenital posteromedial bowing of the tibia and fibula and 1 child with posterior bowing of the tibia and fibula have been followed-up. At the final examination age of the patients ranged from 6 months of 16 years (mean 69 months). In most of the cases the angulation had a tendency to decrease, shortening of the tibia remained constant. Pseudoarthrosis appeared in one of the children in 4th month of life at distal tibial diaphysis/metaphysis junction but healed spontaneously in 13 months time.

Abnormalities, Multiple↗
PubMed1992

[Periosteal and endosteal blood supply of the human fibula and its clinical importance].

The angioarchitecture of the human fibula was investigated by anatomical dissection. The main artery of the periosteal and endosteal blood supply is the arteria fibularis. The proximal part of the facies lateralis is additionally nourished by a well-built branch of the arteria tibialis anterior. The periosteal branches of the arteria fibularis are most voluminous on the dorsal side in the middle of the fibula. Small plates take care of these branches. For an additional revascularization the well-built branch of the arteria tibialis anterior is proposed. The best anatomical region for a vascularized fibular transfer is at an average of 20% up to 75% of the fibular length.

Aged↗
PubMedDate not supplied

Ilizarov lengthening in centralized fibula.

Tibial hemimelia often produces major limb length problems (1,6,9,15) as well as foot deformity. The decision to perform reconstructive surgery depends on the expected leg-length discrepancy, the anomalies of the foot, and the status of the knee (4,6,8,15). Congenital bone deficiencies usually have a constant rate of growth inhibition (8), and leg lengthening is often associated with more complications (5,13). The complication rate is also increased with the increased leg-length discrepancy (5). In tibial hemimelia with functioning quadriceps (types I and II) and a functional foot, centralization of the fibula onto the talus and synostosis with the proximal tibia is an accepted reconstructive procedure (1,4,6,7,9,15). However, when the transplanted fibula produces a functional limb for the patient, the correction of leg-length inequality would be a challenge. This is a report of such a case.

Child↗
PubMed2001

Fibula pseudarthrosis revisited treatment with Ilizarov apparatus: case report and review of the literature.

A case of isolated congenital fibula pseudarthrosis with progressive valgus ankle deformity is reported. Valgus deformity can be corrected early by Ilizarov apparatus. Bone grafting is an essential part of treatment for union of the pseudarthrosis site. Internal splinting may be helpful in preventing further valgus deformity by maintaining continuity of fibula. Age of presentation has an important bearing on the choice of treatment.

Ankle Joint↗
PubMed1979

Fractures of the fibula at the distal tibiofibular syndesmosis.

Two basic fracture types are found at the level of the syndesmosis, supination-external rotation (SE) and pronation-abduction (PA), reflecting the mechanism of injury. The SE-type fracture of the fibula extends from the anterior edge in a posterosuperior direction, and the PA-type fracture extends from the medial surface either transversely or obliquely in a laterosuperior direction, and are often comminuted. The SE-types exist in 2 locations above and below the anterior fibular tubercle. All 3 types exist also in atypical forms. Treatment of the initial stages is by cast immobilization, and advanced lesions are treated by open reduction and internal fixation of the medial and lateral lesions of the ankle. The most common type of Wagstaffe fracture was type 2 which represents fractured anterior spike of the proximal fragment of the fibula.

Adolescent↗
PubMed2001

Use of polymerase chain reaction in diagnosis of occult tuberculosis of the fibula.

An unusual case of tuberculosis of the lower end of the fibula in a young patient is reported. The patient presented with symptoms of pain and swelling over the outer aspect of the right ankle with full range of painless ankle movements. The plain radiographs of the ankle were normal but MRI scan showed increased signals within the lower end of the fibula on T2-weighted images. The histology of the lesion showed only a few Langhans giant cells and culture failed to grow any organism. Polymerase chain reaction analysis of the biopsy specimen, however, showed growth of Mycobacterium tuberculosis. The patient responded to antitubercular treatment with complete resolution of symptoms. Polymerase chain reaction analysis should be considered in atypical presentations with bone pain to rule out an occult infectious pathology.

Adult↗
PubMed2002

[Allograft fibula in treatment of cervical spondylosis].

OBJECTIVE: To evaluate the efficacy of allograft fibula in anterior cervical fusion for cervical spondylosis patients treated by Smith-Robinson operation supplemented with anterior instrumentation. METHODS: The clinical outcome of 38 patients with cervical spondylosis treated by Smith-Robinson operation using allograft fibula supplemented with anterior titanium plate were retrospectively studied. The patients were followed up on average was (9.5 +/- 3.4) months. The average preoperative and postoperative JOA scores were assessed and myelopathy severity was graded using the Nurick myelopathy grading system. Lateral views in neutral position, in flexion, and in extension of preoperative cervical roentgenograms were analyzed in comparison with last follow-up films to identify the changes in the height of intervertebral space and the quality of fusion. RESULTS: Statistical analysis of all patients revealed mean JOA scores of 12.54 +/- 1.62 and 16.07 +/- 1.13 before surgery and at final examination (P < 0.05), respectively. And the mean Nurick grades were 2.46 +/- 0.43 and 0.72 +/- 0.37 before and after surgery (P < 0.05), respectively. Radiographic follow-up revealed that the height intervertebral space and the lordosis of the cervical spine had been restored and no allograft was found displaced or collapsed and also revealed that all grafts obtained union by 5 months after surgery. CONCLUSIONS: Fibular allograft can replace autologous iliac crest graft in the treatment of cervical spondylosis patients. This method is safe and efficacious and can avoid bone graft-site morbidity.

Adult↗
PubMed2002

Reconstruction of the mandible by fibula free flap.

BACKGROUND: The most frequent cause of defect in the mandible is tumor-related surgery. Larger defects or anterior arch defects cause severe morbidity due to disturbances in function and esthetics. OBJECTIVES: To assess the outcome of free tissue transfer for mandible reconstruction. METHODS: Since 1998 we operated on 11 patients with mandible defects using the fibula flap as the reconstruction method. We performed immediate reconstruction in eight patients after ablative surgery, and late reconstruction due to radiation-induced complications in three. RESULTS: All patients achieved good functional and esthetic outcome. During the follow-up period two patients died of their malignant disease and one patient died from a non-related cause. Although two patients underwent reoperation in the first 3 months after their primary operation due to fixation failure, there were no other major complications. CONCLUSIONS: According to the literature and our limited experience, the fibula flap is a safe and reliable option for mandible reconstruction.

Adult↗
PubMedDate not supplied

Effects of irradiation on the appositional and longitudinal growth of the tibia and fibula of the rat with and without radioprotectant.

The effect of therapeutic levels of irradiation on appositional bone growth was compared with its effect on longitudinal growth in the skeletally immature rat model. The widths and lengths of the tibiae and fibulae of young rats were studied at 2, 4, 6, and 12 weeks after exposure to 17.5 Gy x-irradiation to the knee region of the right leg, with and without the aminothiol radioprotectant amifostine 20 minutes before radiation. Irradiation retarded growth in the width of the tibia to a greater extent (19%-27%) than longitudinal growth (9%-21%). The appositional growth discrepancy decreased over time, whereas the length discrepancy increased. The proximal fibula, in contrast, undergoes a normal decrease in width over time, and irradiation retarded this contraction by 14%. Appositional growth does not appear to be spared from the damaging effects of irradiation, but a catch-up phenomenon is observed that is not seen in longitudinal growth. Amifostine reduced the radiation-induced loss in tibial width by 40% to 50% and in length by 12% to 30%.

Amifostine↗
PubMed1992

The osteocutaneous free fibula flap: is the skin paddle reliable?

This clinical and anatomic study was undertaken to see if the skin paddle of the osteocutaneous fibula flap could be made more reliable. Eighty cadaver limbs were dissected to evaluate the type, number, and location of the cutaneous perforators supplying the lateral leg. Three types of perforators were identified: septocutaneous, musculocutaneous, and a type we termed septomuscular, which does not actually run within the muscle substance but is adherent to the muscle. Although not a true musculocutaneous perforator, it should be treated as such clinically. Musculocutaneous perforators were found to be more numerous and more proximal than the septocutaneous perforators. Eighteen clinical cases demonstrate a 33 percent skin paddle survival when dissected as a septocutaneous flap and a 93 percent skin paddle survival when dissected as a septomusculocutaneous flap. In using the osteocutaneous fibula flap, it is recommended that a cuff of soleus and flexor hallucis longus be incorporated into the flap to help ensure flap viability.

Bone Transplantation↗