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PubMed1984

Anatomic study of the nutrient foramen in the shaft of the fibula.

The location of the nutrient foramen is important if a free vascularized fibular graft is to include endosteal as well as periosteal blood supply. More than 300 human fibulae were examined to determine the number, location, and size of the foramina in the shaft. Six percent of the bones had no apparent foramen. Ninety-six percent of the foramina were in the middle third of the fibula. In Caucasians this segment of the shaft should be used for free vascularized fibular transfers to increase the likelihood of including the endosteal blood supply.

Fibula↗
PubMed1982

[Compensatory and stabilizing motions of the fibula].

There are two reasons why the fibula shows longitudinal motions. During dorsiflexion the push of the wedge-shaped trochlea tali causes an upward fibular motion; on the other hand, during weight bearing the contraction of the leg muscles effects a downward fibular motion. The specific level of the fibula results from these two correlating forces. While the upward fibular migration is a passive compensative movement, the downward fibular migration is an active stabilizing movement.

Ankle Joint↗
PubMed1981

The treatment of unstable fractures of the tibia and fibula with flexible medullary wires. A review of two hundred and thirty-five fractures.

A retrospective study was done of the treatment of closed and open unstable fractures of the tibia and fibula with flexible intramedullary wires in 223 patients with 235 fractures. The surgical procedure is relatively atraumatic to the tibia, can be learned easily by the surgeon, and does not require complicated or expensive instrumentation. The flexible intramedullary wires permit stabilization of the fractures in a functional position. External support by a long cast in the initial phase of treatment is necessary, but full weight-bearing is usually allowed during the third to fourth week. This has proved to be a beneficial method of treatment for bilateral fracture of the tibia and fibula and for combined femoral and ipsilateral tibiofibular fractures. Of the 235 fractures, fifty-seven (24.3 per cent) were closed and 178 (75.7 per cent) were open. Primary healing of soft tissue and bone occurred in fifty-three (92.9 per cent) of the closed fractures and in 117 (65.7 per cent) of the open fractures. The complication rate in closed fractures was 7.1 per cent, primarily due to delayed bone union. There was a 34.3 per cent complication rate in the open fractures, of which thirty-one (17.4 per cent) showed delayed soft-tissue healing, ten (5.6 per cent) had delayed bone union, and eight (4.4 per cent) resulted in deep infection with osteomyelitis. There were eight non-unions in the open, uninfected fractures, five of which healed after bone-grafting. Flexible intramedullary wiring of the tibia should be considered as an alternate method of treatment in the presence of an unstable fracture.

Adolescent↗
PubMed1995

[Comparison of donor defects of fibula and iliac crest grafts].

In order to study the donor-site morbidity following osteocutaneous fibula and iliac-crest flaps, 17 patients were asked to answer a questionnaire and to present for a follow-up examination. The donor defect after fibula graft was preferred to the iliac crest donor defect with respect to esthetic appearance and complication rate.

Adult↗
PubMed1995

[Transformation techniques for the fibula of the mandible].

Free flaps from the fibula to rebuild the mandible have allowed for improved results in the reconstruction of this bone. We propose a new and more precise technique to further enhance the functional and esthetic reconstructive result. We base the planning for the free flap on specific measurements obtained on the cephalometric analysis. Preoperative angular determinations allow for more precise fibula osteotomies prior to transection of the donor vessels.

Cephalometry↗
PubMed1993

The Maisonneuve fracture of the fibula.

Nine patients sustained a Maisonneuve fracture of the fibula (MFF), which is a proximal fibula fracture associated with an ankle fracture or deltoid ligament tear. Eight were treated with closed reduction and plaster casts. One was treated by open reduction and internal fixation. Reexamination was performed at an average of 25.7 months. This included subjective, objective, and functional evaluations, along with stress roentgenograms. Six patients had an excellent result, two a good result, and one a fair result. The MFF is often more stable than generally assumed. For injuries with only a partial syndesmotic disruption, nonoperative treatment is recommended.

Ankle Injuries↗
PubMed1996

[Surgical strategy of osteocutaneous free transfer of the fibula in complex mandibular reconstructions: technical notes].

The fibula osteocutaneous free flap now has a recognized place in the therapeutic arsenal of microsurgical mandibular reconstructions. Based on a review of the literature and their own experience, the authors propose a preoperative and intraoperative strategy adapted to reconstructions of mandibular defects. The place of complementary investigations, the site of the skin flap, the choice of osteotomy, the type of fixation, and spatialisation of the skin flap are presented. They conclude on the excellent plastic and vascular qualities of the fibula flap in complex mandibular reconstructions.

Adult↗
PubMedDate not supplied

Complete fibular regeneration following removal of the fibula for bone grafting.

Major bone defects may be reconstructed by either vascularized or not vascularized fibula grafts. No much attention is done so far to the donor site. This article emphasizes on an interesting observation, where almost total regeneration of a subperiosteally harvested fibula graft occurred within the first three postoperative months.

Bone Regeneration↗
PubMed1997

Congenital deficiency of the fibula with ipsilateral iliac horn and absence of the kidney.

Congenital deficiency of the fibula is sometimes accompanied by femoral hypoplasia, genu valgum, patellar a/hypoplasia or dislocation, tibial bowing, foot deformity, and toe deficiency in the affected limb. 'Iliac horns' are bony projections extending posterolaterally from the ilium and considered to be pathognomonic of nail-patella syndrome. We report a 5-year-old Japanese girl with congenital complete deficiency of the left fibula, ipsilateral iliac horn and absence of the left kidney.

Female↗
PubMed1997

Osteosarcoma of the proximal fibula: report of 3 cases.

Osteosarcoma of the proximal fibula represents about 2% of all osteosarcomas. The complexity of anatomical structures in this region led in the past to low transfemoral amputation in order to achieve local control. Three patients aged 14, 13 and 14 were treated in our institution and surgical margins were free of tumour after a wide en bloc resection. To achieve that, the lateral wall of the tibia and the anterior tibial artery were taken out with the proximal fibula. All three patients are alive without evidence of disease. The functional results are evaluated according to Enneking system recommended and adopted by the Musculo-Skeletal-Tumor Society (M.S.T.S). Overall functional results were 80, 100 and 100%.

Adolescent↗
PubMed1997

[Fee flap from the fibula: microsurgical method for the substitution of mandibular loss].

The authors report on the microsurgery method of the vascularized free fibula flap transplantation for the reconstruction of large segmental mandibular defect. They have established from the literatury data and by their own experience of two cases, that the use of free fibula flap seems to be the best replacement method, when the bone defect is bigger then twelve centimeters.

Bone Transplantation↗
PubMed1997

[Secondary reconstruction, after maxillectomy, using an osteocutaneous flap from the fibula. Report of a case].

Surgical functional reconstruction after partial maxillectomy with fibula free flap. A bilateral upper alveolar bone, gingival and palatal defect after tumor resection, has various problems originating from reconstruction with prosthesis or temporalis muscle flap. We report a secondary reconstructive procedure using the fibula osteocutaneous free flap. The combined bone segments created the upper alveolar arch, and the skin paddle closed the palatal defect. This procedure restored the patient to masticatory function of the upper jaw, intelligible speech and natural facial appearance. As a result quality of life of patient was extremely improved.

Aged↗
PubMed1997

[Bosworth's fracture (fracture-luxation of the ankle with retro-tibial luxation of the fibula). Presentation of a case].

The author reports a case of fracture-dislocation of the ankle associated with a posterior dislocation of the proximal part of the fibula behind the tibia: Bosworth's fracture. Hugier first described this "new dislocation of the ankle" in 1848, and Bosworth classified it in 1947. Because the correct diagnosis was not done at first in our patient, our attempt at closed reduction failed. Open reduction was performed, followed by internal fixation of the fibula. A good functional result was obtained at 12 weeks.

Ankle Injuries↗
PubMedDate not supplied

Management of gap non-union of tibia by tibialisation of ipsilateral vascular fibula.

Gap non-union of tibia following traumatic bone loss or infection dramatically emphasizes the limitation of conventional reconstructive techniques. With presence of significant skin loss or poorly vascularised recepient bed, complications and failure rate increase and solution often lies in amputation. Vascularised ipsilateral fibular grafting offers a viable alternative to this. This is a series of 16 cases of gap non-union of tibia treated by tibialisation of fibula at KEM Hospital, Bombay. All the cases were secondary to osteomyelitis following compound fracture of tibia-fibula or hematogenous osteomyelitis with a large sequestrum. 15 cases had good results with good hypertrophy of bone after union. One case had poor result with fracture going into delayed union with no hypertrophy. We discuss the technique, complications and results of this procedure.

Adolescent↗
PubMed1997

[Free fibula transplant and practical approach in the absence of posterior tibial artery. A report of 2 cases].

The authors report two well documented cases of absent posterior tibial artery in patients undergoing free fibula transplant. The first patient was a 50-year-old woman treated by pelvimandibulectomy for squamous cell carcinoma, leaving a defect of the floor of the mouth. The second case was an 11-year-old child with Ewing sarcoma of the femoral metaphysis, in whom femoral reconstruction was performed by vascularized free fibula transplant. Based on these two cases, the authors describe their diagnostic and therapeutic approach designed to avoid risks associated with this anatomical variant. Absence of the posterior tibial artery can be confirmed by arteriography and duplex ultrasound. The authors propose duplex ultrasound as first-line investigation as this safe, noninvasive examination provides sufficient information in the majority of cases at a lower cost. In parallel, the various anatomical variants affecting the origin of leg arteries from the popliteal artery are classified into seven groups based on a phylogenetic and embryological study.

Bone Neoplasms↗
PubMed2002

Microsurgical reconstruction of lower limb bone defects following tumor resection using vascularized fibula osteoseptocutaneous flap.

This study included 25 patients with lower limb tumors who had wide local resection and reconstruction by vascularized fibula osteoseptocutaneous flap, and who had their surgery performed at least 24 months before the end of the study. The average age at operation was 23.5 years. Twenty-three tumors were malignant;16 were staged as high-grade sarcomas (stage IIA, stage IIB, and Ewing's sarcoma). Tumor volume averaged 293.2 cc (range, 41.4-860). The resulting defect after tumor resection averaged 16 cm (range, 9-20 cm). The fibula was inserted as a single strut in 21 patients, and as a double-barrel construct in 4 patients. Fixation was augmented by interlocking nail in 11 cases, bridge plate in 9 cases, and external fixator in 5 cases. Twenty-four (96%) flaps survived. All grafts united in an average period of 4.5 months (range, 3-8 months) after transfer. Two secondary procedures were necessary to achieve graft union. Full weight bearing was possible after an average period of 7.5 months (range, 5-14 months). Significant hypertrophy (> or =30% of original fibular diameter) occurred in 85% of patients after an average period of 10 months from the index operation. In the latest follow-up radiographs (mean, 32 months), the degree of hypertrophy averaged 90% (range, 30-200%). Graft fracture occurred in three patients, and all healed conservatively. The Musculoskeletal Tumor Society rating score (MTSRS) averaged 21.2 points at the end of the first postoperative year, and 23.6 at the end of the study.

Adult↗
PubMed1996

Biomechanical studies of transthoracic vertebral body replacement with autologous bone grafts (fibula and rib).

Thoracic processes which destroy vertebral bodies leave gaps which usually have to be bridged. The aim of our experiments was to find out whether rib and fibula grafts are suitable vertebral body substitutes from the biomechanical point of view. Therefore, we examined characteristics of vertebral body/bone graft/vertebral body arrangements under the influence of pulsating compression forces in a testing machine. The deformation of the rib graft alone was 0.78 mm under a preselected peak load of 1010 Newton. When the rib graft was placed between two vertebral bodies, the deformation (creeping) was 6 mm under a peak load of 1010 Newton. The deformation of the fibula graft alone was 0.41 mm, and when placed between vertebral bodies maximally 3 mm. The results of our experiments lead to the conclusion that ribs modified according to our design are prinzipally suitable for vertebral body replacement in the thoracic region as far as primary stress resistance is concerned. Characteristics of these bone grafts in the human body are being followed-up.

Biomechanical Phenomena↗
PubMed1993

Enhancing fibula free flap skin island reliability and versatility for mandibular reconstruction.

Although the fibula osteocutaneous free flap has many advantages when used in mandibular reconstruction, many investigators have found the skin island is not always reliable. We present a technique that enhances skin island reliability by including a maximal number of skin perforators. This method has been used in 10 consecutive osteocutaneous free flaps without any skin loss. This technique also expands the usefulness of the fibula free flap, allowing it to be used for shorter bone defects or in cases when skin coverage is needed at a distance from the bone. In addition, this method provides additional vascularized soft tissue for neck contour restoration and coverage of fixation plates.

Bone Plates↗