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PubMed1993

Effect of upper tibial osteotomy on fibula movement and ankle joint motion.

Several techniques of upper tibial osteotomy in the treatment of unicompartmental osteoarthritis of the knee have been described. Osteotomy of the fibula is normally also carried out, or alternatively, dissection of the capsule of the proximal tibiofibular joint. There is concern, however, that this latter procedure may have an adverse effect on the mobility of the ankle joint and on fibula rotation. To investigate these suspected interactions we performed experimental studies in 14 cadaver legs. The vertical, lateral and rotational movements of the fibula were measured with the ankle in neutral (0 degrees) and maximal ankle dorsiflexion before and after performing an interligamental upper tibial osteotomy of a standardised valgus wedge. Maximal ankle dorsiflexion before the osteotomy produced external rotation of the fibula in most specimens, whereas after osteotomy this movement caused mainly internal rotation. In the neutral position of the ankle, upper tibial osteotomy lead to external rotation of the fibula. The upward movement of the fibula head after osteotomy was 0.64 cm on average. There was no measurable vertical motion of the fibula during ankle dorsiflexion either before nor after upper tibial osteotomy. Ankle dorsiflexion improved minimally after osteotomy. In conclusion, this study shows that upper tibial osteotomy with dissection of the capsule of the proximal tibiofibular joint has no adverse effect on movement of the fibula or of the ankle joint. In addition, unlike fibular osteotomy, this technique also has the advantage that the risk of common peroneal nerve injury is minimal.

Ankle Joint↗
PubMed2004

Radiographic differentiation of enchondroma from low-grade chondrosarcoma in the fibula.

To evaluate demographic and radiographic features that may differentiate between enchondroma and low-grade chondrosarcoma of the fibula. The radiographs of ninety-three histologically-confirmed cartilaginous tumors of the fibula were retrospectively reviewed along with demographic information as to patient age and gender. Fifty-four enchondromas and thirty-nine low-grade chondrosarcomas were included in the study. Multiple previously-established radiographic features distinguishing enchondroma from chondrosarcoma were evaluated in each fibular tumor in a consensus manner by two experienced, board-certified and fellowship-trained musculoskeletal radiologists. Five radiographic features were shown to statistically favor chondrosarcoma over enchondroma in the fibula. These were soft-tissue mass ( p<0.0001), periosteal reaction ( p=0.008), cortical disruption in the juxta-articular fibula ( p=0.0133), cortical thickening ( p=0.032), and tumor size greater than 4 cm ( p=0.0046). No statistically-significant demographic differences were found between patients with enchondroma and chondrosarcoma of the fibula. When two or more of the identified features of malignancy are identified in the same patient, chondrosarcoma is 2.4 times more likely than in those patients exhibiting none of the features of malignancy. Soft-tissue mass, periosteal reaction, cortical disruption in the juxta-articular fibula, cortical thickening, and tumor size greater than 4 cm indicate chondrosarcoma over enchondroma of the fibula. Radiographs demonstrating more than one of the identified malignant features are more likely to be due to chondrosarcoma than radiographs demonstrating none or only one of the identified features. No unique malignant features of chondrosarcoma in the fibula were observed when compared to previous descriptions of these tumors in the long and short tubular bones of the appendicular skeleton.

Adolescent↗
PubMed2005

Septocutaneous perforators of the peroneal artery relative to the fibula: anatomical basis of the use of pedicled fasciocutaneous flap.

There are many studies describing the perforating branches of the peroneal artery but none of them identifies their locations relative to fibula. The aim of this study was to demonstrate the locations of the perforators relative to the fibula and to present a case, treated with an adipofascial flap, based on one of these small arteries. In this study, nine fresh male cadavers' legs injected with colored latex were dissected for demonstration of the longitudinal axis of these perforators. A large incision was made on the lateral part of the leg from the head of the fibula to the ankle. The peroneal perforating vessels were displayed. The posterior margin of the fibula was marked with needles from proximal to distal just above every perforator. The distance between the needle and the perforator was recorded. Their diameters were measured at the level of fascial emergence. There were four to seven perforating vessels; the larger vessels were near the proximal end of the fibula with an average of 1.1 mm and a minimum of 0.8 mm. We found that these branches were not parallel to fibula, but aligned in an oblique projection from posterior to anterior and from distal to proximal because of the course of the intermuscular septum between the soleus and peroneus longus muscles. The lowermost vessel was 1.7 cm away from the posterior margin of the fibula while the uppermost vessel was 0.25 cm away from the posterior ridge of the fibula. Adipofascial or fasciocutaneous flaps, which have important advantages in covering small to medium sized defects, can be based on the perforators of the peroneal artery. But for the centralization of the flap pedicle, the locations of the perforators, which are aligned from the lateral malleolus to the fibular head in oblique direction and from the posterior to the anterior must be taken into consideration. This knowledge is crucial for the flap design and the centralization of the vessels.

Adipose Tissue↗
PubMed2001

Topographical anatomy of the fibula and peroneal artery in Koreans.

Vascularized fibula flaps have many advantages in the restoration of the contour and function of the mandible. Potential disadvantages include, unreliable skin paddle and the limited volume of the fibula. This study was designed, to clarify the anatomy of the peroneal artery to the fibula and lateral leg skin, and to measure the dimensions of the fibula available for dental implant placement in Korean. Through the dissection of 63 legs of Korean cadavers, we demonstrated that in most cases the musculoperiosteal (mp) and septocutaneous (sc) branches of the peroneal artery were distributed at the middle and lower thirds of the fibula. There were double the number of mp perforators to the skin compared to sc branches. This indicates the inclusion of a generous > 1 cm cuff of Peroneous longus and flexor hallucis longus (FHL) in the distal and middle third of the fibula. The location of the nutrient foramen was just proximal to the midpoint. Thus, a 15-20 cm length of the fibula is available in Koreans and an 8 12 mm length of implant can be placed to the fibula, which provides sufficient bone to reconstruct a large mandibular defect.

Adolescent↗
PubMed1994

The need for preoperative leg angiography in fibula free flaps.

Among arterial anatomic conditions which will adversely affect the harvest of the fibula are 1) significant arteriosclerotic disease within the tibial-peroneal vessels; 2) peroneal arteria magna (PAM), a condition in which only the peroneal artery supplies the foot; and 3) absence of the peroneal artery, either congenitally or as an acquired defect. In each of these anatomic conditions, removal of the peroneal vessels and the fibula free flap will jeopardize either the donor leg, the fibula flap, or both. All patients considered for fibula flaps were evaluated with preoperative leg angiograms. In 28 consecutive patients evaluated with angiography for planned free-fibula flap reconstructions, 23 actually underwent free-fibula harvest. Angiographic abnormalities that altered the operative plan were found in seven (25 percent) patients. Four of the seven patients had vascular examinations prior to surgery with abnormal findings. Three of the seven (11 percent) patients with abnormal arterial anatomy had normal vascular examinations prior to surgery. Thus, if a preoperative angiogram had not routinely been done, the abnormal anatomy would not have been discovered until surgery. This could have resulted in an unusable flap in one patient, and an ischemic or gangrenous foot in two other patients. With this angiographic guidance, there were no vascular complications from harvest of the fibula. The routine use of preoperative bilateral leg angiography is recommended, or an alternative method of vessel imaging, in all patients evaluated for microvascular free-tissue transfer of the fibula.

Angiography↗
PubMed1999

Anterior cervical discectomy with freeze-dried fibula allograft. Overview of 317 cases and literature review.

STUDY DESIGN: A retrospective review of 317 patients to determine the efficacy of allogeneic fibula arthrodesis after anterior cervical discectomy. OBJECTIVE: To examine the efficacy of allogeneic fibula as an alternative fusion substrate after anterior cervical discectomy, and to determine the effects of cigarette smoking on the healing of fibula allografts. SUMMARY OF BACKGROUND DATA: The use of autogeneic iliac crest is associated with graft harvest complications in up to 20% of patients. Most studies reporting on the use of allogeneic iliac crest cite a high collapse rate. Few studies exist that note the efficacy of allogeneic fibula in this procedure and the effects of cigarette smoking on fusion rate. METHODS: From 1988 to 1993, 317 patients underwent grafting by the Smith-Robinson technique with allogeneic fibula after anterior cervical discectomy. Patients who described themselves as habitual cigarette smokers or who smoked during the perioperative or postoperative period were categorized as smokers. All patients were immobilized in a rigid cervical orthosis (Philadelphia collar) for at least 10 weeks postoperatively. RESULTS: A minimum of 2 years follow-up was achieved in 289 patients. In all, 162 men and 127 women had a total of 311 levels grafted, and the mean follow-up period was 33 months (range, 24 to 51 months). Of patients who received allogeneic fibula at one level, 90% (242/269) achieved radiologic fusion. The fusion rate was 92% (182/198) among nonsmokers compared with 85% (60/71) among smokers (not a statistically significant difference; P = 0.120). After two-level procedures, 72% (13/18) of the patients showed fusion. The fusion rate was 50% (2/4) among smokers compared with 79% (11/14) among nonsmokers (P = 0.53). When one-level arthrodesis (90%) was compared with two-level arthrodesis (72%), the difference approached statistical significance (P = 0.054). Neither of the two patients, both nonsmokers, who received grafts at three levels achieved fusion. There were no infections, and no grafts collapsed. Two grafts extruded (0.6%), but these were partial and did not require reoperation. Both patients fused and constituted the only patients with more than 10 degrees of angulation in the series. Graft subsidence occurred in 5% (17/311) of the grafts, mostly in the beginning of the series, and was not problematic. This phenomenon was thought to have been caused by overaggressive removal of the cortical endplate. CONCLUSION: Allogeneic fibula is an effective substrate for use in achieving fusion after anterior cervical discectomy. Maximal results are achieved with its use at one level in nonsmokers. Cigarette smoking decreased the fusion rate with allogeneic fibula in the anterior cervical spine, but not by a statistically significant amount.

Cervical Vertebrae↗
PubMed1996

Banked fibula and the locking anterior cervical plate in anterior cervical fusions following cervical discectomy.

Eighty-eight consecutive patients underwent anterior cervical discectomy (ACD) with banked fibula fusion and internal fixation using the locking cervical plate. Pathology included cervical spondylotic radiculopathy in 48, cervical spondylotic radiculomyelopathy in 30, cervical facet dislocations with associated disc herniations in six, and autologous iliac crest graft collapse pseudoarthrosis with recurrent symptoms in four patients. Operations were single-level banked fibula fusion with plating in 37, multilevel banked fibula fusion with plating in 45, and combined single-level ACD banked fibula fusion with plating and posterior fusion in six patients. The only perioperative complication was transient hoarseness. There were no transfusions, infections, neurological injuries, or deaths. The mean time in the hospital for the nontraumatic cases was 1.8 days. The mean follow up was 22 months (range 12-30 months). There has been no motion at the fused level on flexion/extension films, no kyphosis, no screw plate backout, and no banked fibula has suffered graft collapse. Following a high-speed motor vehicle accident 6 months after a multilevel fusion, one alcoholic man suffered a fractured plate with transient worsening of neck pain, and the plate has remained in place for an additional 11 months of follow-up care. Compared to 100 consecutive autologous iliac crest fusions performed by the same surgeon, there were significantly fewer graft-related complications (p < 0.001). There was a significantly greater chance of autologous iliac crest collapsing with the passage of time as compared to banked fibula. Time until return to work was shorter by 5 weeks for the plate/banked fibula group (p < 0.05). When fusion is considered following ACD, the combination of banked fibula and locking cervical plates is significantly superior to autologous iliac crest grafts.

Adult↗
PubMed2000

[Treatment of tibia and femur massive defect with pedicled fibula transposition].

OBJECTIVE: To investigate the repairing result for the massive bony defects of upper and middle tibia and lower femur. METHODS: Since 1974, four types of pedicled-fibula transposition were performed to repair the massive bone defect of tibia and femur in 25 cases, which included; 9 cases with benign tumor of upper part of tibia were performed muscle-pedicled fibula transposition and knee fusion after tumor resection; 9 cases with extensive benign tumor or tumoroid lesion of tibia shaft were performed muscle-pedicled fibula transposition and tibia-fibula fusion after tumor resection; 2 cases with extensive benign tumor or tumoroid lesion of middle and lower parts of tibia were performed vascular pedicled fibula transposition and tibia-fibula fusion; 5 cases with benign tumor of distal femur were performed vascular pedicled fibula reversal transposition and knee fusion. RESULTS: After 3 months to 11 years follow-up, 23 cases showed bone healing at 6 months postoperatively. The other 2 cases showed bone healing at 12 months postoperatively. All cases had satisfactory functional rehabilitation. CONCLUSION: Pedicled-fibula transposition is a choice method for repairing massive defects of tibia and femur.

Adolescent↗
PubMed1992

Biomechanical study on the load-bearing characteristics of the fibula and the effects of fibular resection.

The objective of this research was to investigate the load-bearing function of the fibula in relation to donor leg morbidity in patients who have had fibular resections. Biomechanical loading experiments were performed on ten anatomic specimens. Force transducers were mounted in place of resected tibial and fibular segments to allow load transmission to be measured. Load transmission through the fibula varied with ankle position. With the ankle at neutral position, the load distribution to the fibula averaged 7.12% of the total force transmitted through the tibia and fibula. Maximum loads occurred at full dorsiflexion and eversion. Resection of the proximal fibula results in a significant reduction of load through the distal fibular remnant. The values varied between 0.62% and 0.81% of the total force transmitted. When a cortex screw was introduced to anchor the distal fibula remnant to the tibia, the load distribution to the distal fibula remnant was partially restored with values ranging from 1.71% to 5.14% of the total force transmitted depending on the different ankle positions. These observations suggest that more consideration of the loading characteristics of the fibula should be taken into account in planning resection operations.

Biomechanical Phenomena↗
PubMed2006

Reliability of vascularized fibula in maintaining arthrodesis following extra-articular wide excisions of malignant musculoskeletal tumors.

OBJECTIVE: To evaluate the reliability of vascularized fibula transfer in maintaining arthrodesis following wide excision of malignant tumors located at the metaphyseal ends of long bones. METHODS: Fourteen patients underwent wide extra-articular excisions followed by arthrodesis with vascularized fibula and its variants at the Department of Orthopedic Surgery and Traumatology, University of Hacettepe Medical School, Ankara, Turkey, in the period from 1996 to 2003. There were 9 males and 5 females. Their mean age was 28 years (ranging 12-52 years). The mean follow-up time was 68 months (range 28-110 months). The most common diagnosis was malignant giant cell tumor (6), followed by Ewing's sarcoma (3), hemangioendothelioma (2), osteosarcoma (2) and chondrosarcoma (1). Three tumors were located at the distal end of the radius, 4 at the proximal humerus, 3 at the distal femur, one at the proximal tibia, one in distal tibia, one in distal humerus and one in proximal ulna. We used fibula as a vascularized graft in 4 patients; fibula osteoseptocutaneous flap in 4 cases; bilateral vascularized fibulae in 3; fibula with autoclaved autograft in 4 and free osteoseptocutaneous fibula in conjunction with a structural allograft and a circular external fixator in one patient. RESULTS: In 4 cases, implant failure developed and revision was required in 3. One case had local infection around the distal interlocking screw. In one case, clawing of first and second toes were developed at the donor side. Two patients with metastatic Ewing's sarcoma had metastatic disease. We achieved union within 9 months in 12 cases. In 2 cases with implant failure, bony consolidations were maintained at 11th and 13th months. CONCLUSION: Vascularized fibula transfer is reliable to achieve arthrodesis following extra-articular excision of malignant tumors from the metaphyseal ends.

Adolescent↗
PubMed1993

[Clinical and roentgenologic changes after fibula resections: causes, differential diagnostic aspects, consequences].

This study correlates the clinical and radiological development of twelve patients with resection of the fibula, with the results of experimental investigations, reporting on the loss of tension-banding and proportional weight-bearing after fibula resection. Five patients underwent segmental fibula resection because of tumour disease, seven patients by reason of harvesting an intercalary allograft. Five patients suffered from lower leg pain. Spindle-shaped thickenings of the tibial cortex could be confirmed by most x-rays, in one case the tibial shaft diameter increased up to 10%. Usually the rest of the fibula will become atrophic in grown-up patients; in children the fibula may restore completely if the preparation is performed by sparing the periosteum. Three patients suffered a stress fracture of the tibia. As pain and tibial stress fracture appeared mainly if the remaining fibula was less than 1/4th of the original fibula length, the distal part should be preserved longer if justifiable from an oncological point of view. The knowledge about basic biomechanical behaviour and the arising possibility of a stress fracture or other structural changing of the tibia after fibula resection is important for correct assessment of the postoperative clinical and radiological development.

Adolescent↗
PubMed1996

[Reconstruction of the long bones of the legs in children via free vascularized transplant of the fibula after resection for sarcoma].

Nineteen children were operated on between 1985 and 1994. All the patients presented a sarcoma of long bones: osteosarcoma: 12 and Ewing's sarcoma: 7. They were operated on: resection and reconstruction of the long bones with a free vascularised fibula. Pre and post-operative chemotherapy was used. The average follow-up was 3 years (between 10 years and 1 year). The mean bone defect was 20 cm (between 32 and 11 cm). Boys were more frequently encountered [12]. Average age was 9.5 years. The pathological bone was: femur: 14, tibia: 4, humerus 1. The approach needs usually two incisions for femoral bone: the internal incision allows us to prepare the recipient vessels: deep femoral vessels in 11 cases. In 18 cases, union occurred in less than 14 months. One case of pseudarthrosis occurred. Immediate follow-up was simple in 17 cases. Infection was observed in 2 cases. Secondly, the most frequent complications were: fracture of the fibula: 6 cases, vicious cal: 2 cases; delayed union: 6 cases; stiffness: 2 cases. One patient died later from pulmonary metastasis. Solid osteosynthesis of the member and of the free vascularised fibula permit to shorten these delays. Success depends on two criteria: the graft thickening of the fibula and union of the fibula at both ends. The micro vascular anastomoses must be excellent. Twelve children had bone union with only one operation. In the 6 cases of delayed union, secondary bone grafts give consolidation. The comparison of this technique with standard treatment showed an evident superiority of the free vascularised fibula transplant in extensive defects of bone. The fibula is a life bone which permits rapid union with a short hospitalization, a quick recovery and an early return to school. Free vascularised fibula permit to ameliorate the quality of survival.

Bone Neoplasms↗
PubMed2003

Relationship of the common peroneal nerve and its branches to the head and neck of the fibula.

The common peroneal nerve (CPN) lies on the neck of the fibula, which forms the floor of the so-called 'fibular tunnel.' The tunnel entrance is a musculo-aponeurotic arch derived from the soleus and peroneus longus muscles and it is here that the CPN is commonly compressed in cases of peroneal nerve palsy. This study aims to define the relationship of the CPN and its branches to the apex of the head of the fibula and to the tunnel, with special regard to possible sites of entrapment. The distances from the apex of the fibula to the opening of the fibular tunnel, the CPN bifurcation, and the exit point of the deep peroneal nerve (DPN) from the tunnel, were measured in 30 legs to ascertain possible sites of entrapment. The angle that the CPN subtended with the long axis of the fibula was measured to gauge the range of positions of the CPN at the neck of the fibula. An unyielding musculo-aponeurotic fibular arch at the entrance to the fibular tunnel was confirmed in all specimens. The DPN exited through a crescentic opening in the anterior intermuscular septum in all cases and no DPN branches were found in the lateral compartment in any specimen. The mean (+/-SD) distance from the apex of the head of the fibula to the opening of the fibular tunnel was 3.2 +/- 1.0 cm, to the CPN bifurcation was 3.8 +/- 0.9 cm, and to the DPN exit point was 7.0 +/- 1.5 cm. The mean angle subtended anteriorly from the long axis of the fibula by the CPN was 18.9 +/- 9.0 degrees. We recommend further study of the mean distances and reference angle in relation to fibular landmarks, for use in possible minimally invasive surgical procedures to decompress the fibular tunnel.

Aged↗
PubMed1995

Evaluation of osseointegration of endosseous implants in radiated, vascularized fibula flaps to the mandible: a pilot study.

PURPOSE: This study clinically evaluated the osseointegration of implants placed into vascularized fibula flaps used in mandibular reconstruction of cancer patients following radiation treatment and subsequent hyperbaric oxygen (HBO) therapy. MATERIALS AND METHODS: Five head and neck cancer patients had mandibular resection and immediate reconstruction with a vascularized fibula flap. Subsequent therapy included greater than 50 Gy of radiation to the fibula flap over a 6 to 8-week period. Two to 6 weeks following radiation therapy each patient received 20 90-minute daily sessions of HBO at 2.4 atmosphere pressure. Stage 1 implant surgery was performed placing two to six implants (15 mm in length and 3.75 to 4.0 mm in width) into each fibula flap. This was followed by 10 postoperative HBO sessions using the previously mentioned protocol. The stage 2 procedure was performed 6 months after the stage 1 procedure. Osseointegration was assessed clinically using manual force and an electronic device at the time the implants were uncovered and monthly over a 6-month period. RESULTS: All 20 implants placed in the fibula flaps were osseointegrated clinically at the time the implants were uncovered and during the 6-month follow-up. CONCLUSION: In this pilot study, mandibular reconstruction with a vascularized fibula flap and endosseous osseointegrated implants, following radiation of the fibula, was successful. It was concluded that factors such as the graft having its own blood supply and the use of HBO contributed to the successful osseointegration of these implants.

Bone Transplantation↗
PubMed2005

Intact fibula improves fracture healing in a rat tibia osteotomy model.

Rat tibia fractures are often used in fracture healing studies. Usually the fracture is stabilized with an intramedullary pin, which provides bending stiffness, but little torsional stiffness. The objective of this research was to determine the in vitro torsional rigidity of an osteotomized tibia with and without the fibula, and to determine if this difference influences the healing process in vivo. In vitro eleven rat tibias received an osteotomy, were stabilized with an intramedullary pin, and were tested in internal rotation to determine the torsional rigidity. The fibula was then manually broken and the torsional rigidity measured again. In vivo 18 rats received a tibial osteotomy, eight of which had an additional fractured fibula. After three weeks, the rats were sacrificed and the tibias were analyzed. Bone density in the fracture callus was measured with qCT. Bending rigidity and maximum breaking moment were determined in three-point bending. In vitro testing demonstrated that the torsional rigidity with an intact fibula was nearly two times higher than when the fibula was fractured. Though the torsional rigidity was still small in comparison with an intact bone, it resulted in a significantly different healing process in vivo. Rats with intact fibulas had significantly higher bone mineral density, bending rigidity, and maximum breaking moment compared to rats with a fractured fibula. These results indicate that torsional stability considerably affects the healing process. In a fracture model, it is critical to characterize the mechanical environment of the fracture.

Animals↗
PubMed1993

Double vascularized fibulas for reconstruction of large tibial defects.

Vascularized fibular grafts have proven to have many advantages over nonvascularized transplants for treatment of large segmental bone defects in the extremities. Fibulas are typically impacted into the medullary canal and fixed with wires or screws. Consolidation has often been delayed and full weightbearing was only possible after graft hypertrophy, usually 12 to 18 months after reconstruction. In order to shorten the time of consolidation and to achieve early full weightbearing, the authors propose a sound biomechanical reconstructive concept: a) stable but not devascularizing osteosynthesis of the osteotomy to shorten the time of consolidation; b) a double-strut fibular graft that yields enough strength for early weightbearing, without the need for bone hypertrophy; and c) additional cancellous bone grafts, to enhance the long-term stability of the reconstruction. Seven patients with tibial defects ranging between 6 and 17.5 cm were treated according to this concept. In four cases, free vascularized fibula was transferred first. Six weeks later, a vascularized, ipsilateral fibula-pro-tibia procedure was done, and the space between the fibulas was filled with cancellous bone grafts. In three patients, a free, vascularized, double-barrel, fibula transfer was done, since the tibial defect was less than 10 cm. Cancellous bone grafts between the fibulas were added only 6 weeks later. In five cases, the free fibula transfer was combined with a latissimus dorsi myocutaneous flap. In six patients, healing was uneventful. In one patient, hypoperfusion of the lower extremity and the vascularized grafts eventually resulted in a below-knee amputation. In all six successful cases, union resulted within 3 months.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1997

A new technique for complex fibula fracture fixation in the elderly: a clinical and biomechanical evaluation.

OBJECTIVE: To determine whether intramedullary fixation could augment plate fixation strength in comminuted and osteopenic fibula fractures. STUDY DESIGN: Retrospective clinical study and biomechanical laboratory study. METHODS: Twenty comminuted or osteopenic fibula fractures in twenty patients age fifty years or older were stabilized using plate fixation augmented with intramedullary Kirschner wires. Nineteen patients were available for follow-up which averaged 15.4 months (range, 6-43 months). In conjunction with this clinical series, a biomechanical evaluation was performed comparing fixation of mildly osteopenic fibulas using this technique to plate and screws alone. The fibulas were first tested non destructively in bending, and then destructively in torsion to determine stability and ultimate strength of the fixation. RESULTS: All nineteen fractures united without loss of reduction: seventeen of nineteen patients (89%) had either no pain, slight or mild pain. Biomechanical testing demonstrated that the resistance to bending of the plated fibulas augmented with Kirschner wires was 81% greater than the fibulas stabilized with a plate alone (p < .05). In torsional testing, the augmented group had twice the resistance to motion than the plate group (p < .002). CONCLUSION: This clinical series and biomechanical study support the use of plate fixation augmented with intramedullary Kirschner wires for the treatment of comminuted and osteopenic fibula fractures in the elderly.

Aged↗
PubMed2005

Efficacy of dental implants placed into fibula-free flaps for orofacial reconstruction.

OBJECTIVES: The transfer of the osseofasciocutaneus fibula-free flap has become a routine procedure in the reconstruction of comprehensive orofacial defects. Besides its length, major advantages of the fibula-free flap include the trigonal diameter of the fibular bone, which usually allows the placement of dental implants. PATIENTS AND METHODS: In a prospective study, 16 consecutive patients who received free fibula grafts and in total 51 dental implants between 1999 and 2001 were examined. All implants were inserted secondary after bone grafting and loaded after 3 months of submerged healing. The observation period extended 2.5 years on average. The implant success was controlled clinically, radiographically and by resonance frequency analysis. RESULTS: One implant that was located at the interface between the fibula graft and the mandible was lost due to dehiscence and local infection during the healing period. In two other patients, one implant had to remain unexposed as 'sleeper' due to an unfavourable soft tissue situation. The success rate calculated by Kaplan-Meier analysis was 96.1% after an observation period of 1400 days. Resonance frequency analysis (ISQ-values) revealed significant differences related to the orientation (vestibulo-oral/mesio-distal; vo/md) of the transducer unit (P < 0.01). In general, a high primary stability for implants placed in free fibula grafts could be achieved (vo/md 66/74.1), which on average increased slightly during the healing period (vo/md 67.4/75.4) and within 12 month of functional loading (vo/md 72.1/79.9). Additional augmentation with iliac bone grafts or reconstructions with a double barred fibula resulted in an improved reconstruction of the alveolar process, thus allowing superior individual implant positions or angulations, but no elevation of the ISQ-values. CONCLUSION: The fibula-free flap provides a consistent bone graft that allows a reliable and predictable restoration with dental implants.

Adult↗