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We present a case of ultrasonographic prenatal diagnosis at 24 weeks of femur-fibula-ulna (FFU) complex. To our knowledge, this is the first report of an early prenatal diagnosis of FFU.
We have studied the results of reconstruction of a large skeletal defect using a vascularized fibula graft in 62 consecutive cases. We were particularly interested in factors that may significantly influence the outcome of union. In at least 90% of cases, eventual union can be expected in the reconstruction of large skeletal defects resulting from tumour resection, traumatic bone loss, or nonunion. The results of reconstruction for osteomyelitis were less favorable. Statistical analysis of the influences of bone graft polarity, internal fixation, additional bone graft polarity, internal fixation, additional bone graft material, and the length of the graft on the outcome of union revealed that the use of stable fixation and additional bone graft material significantly enhanced bone union, whereas the length or polarity of the graft had no influence.
Atypical mycobacterium osteomyelitis is rare. An 81 year old woman has been found to have an osteomyelitis of the upper end of the fibula due to mycobacterium avium complex. The occurrence may be related to advanced age and chronic respiratory disease. Treatment by surgery and drugs has been successful over two years of follow-up.
The present paper describes an experimental model where union was delayed in an osteotomy gap of the rabbit fibula by means of a silicone rubber spacer during 48 days. After the silicone spacer had been removed, electrical transistor regulated direct current of 20 microampères delivered through stainless steel electrodes was used to stimulate osteogenesis on the right side during 62 days. On the left side a sham operation inserting stainless steel electrodes without current was performed. In one out of six animals overbridging callus was received on the stimulated side. In the rest of the animals a high frequency of synostoses between the fibular ends and the tibia was found. There was no significant difference in synostosis formation between the right and the left side. No adverse effect of the current could be detected histologically.
Shortening of the distal fibula after malleolar fracture is accompanied with important alterations of the biomechanics and the compressive forces of the ankle joint. The relationship between the extent of shortening, the degree of valgus position of the talus and the reduction of the joint surfaces is described on the basis of experimental investigations. The importance of these circumstances for treatment of malleolar fractures is discussed.
A case of an adamantinoma of the tibia and fibula is described in a 10-year-old girl who died after 17 years with pulmonary metastasis. For a long time, an exact diagnosis couldn't be made. Histologically the lesion was called chronic osteomyelitis (Brodie's abscess), synovial sarcoma and spindle cell sarcoma. The revision of the histological sections revealed a fibrous dysplasia-like pattern in the first lesion of the tibia with tiny foci of an epitheloid-like pattern. This had could be the key to the right diagnosis, because sometimes adamantinoma of long bones is associated with a fibrous dysplasia-like pattern. The reason for misinterpretation of the histological features is seen in the typical variable histological pattern of this tumor (basaloids, squamoid, spindled and tubular pattern). In this connection is refered to the necessity to correlate the histological feature with the X-ray in making diagnosis in bone pathology.
An apparently hitherto undescribed, severe skeletal syndrome is reported in 3 siblings (2 boys, 1 girl) in a family of Turkish-Arabian descent. Major manifestations include: hypoplasia of the pelvis, congenital dislocation of the hip, severe bowing of femora, aplasia or hypoplasia of fibulae, absence or coalescence of tarsal bones, absence of various metatarsals, hypoplasia and aplasia of toes, clinodactyly, hypoplasia of fingers and fingernails, and postaxial polydactyly. Consanguinity is denied, but the fact that both parents belong to the same Christian minority from the same province may indicate common ancestry. Autosomal recessive inheritance is presumed.
A 5-year-old girl is reported with small stature, unusual facial appearance, polycystic kidneys and elongated curved fibulae as the most impressive radiographic finding. From the close similarity with another girl described recently and discrepancies between these two patients and others with Melnick-Needles syndrome it is assumed that they may present a separate hitherto unreported entity or syndrome.
The emphasis of this case report is on the management of a radial defect after diaphysectomy complicating acute hematogenous osteomyelitis in a 15-month-old girl. An autogenous fibular graft was used to replace the defect of the radius. It was wedged between the proximal and distal radial fragment and fixed in position by two miniplates. After 6 weeks the fibula had incorporated. The graft fractured, unfortunately, through a drill-hole created for neovascularization, requiring further interventions until complete cure occurred. A re-examination 2 years after grafting revealed a good functional result. Radiographically, the radius was completely remodeled. We consider the autogenous fibular graft to be especially suitable for replacing the radius for the following reasons: it is firm enough for bridging, it has a corresponding caliber, and it can be obtained with adequate length. Within a few weeks the fibular defect refills with new bone formation, provided that the periosteum has been tightly sutured. No interference with ankle growth was observed.
A stress fracture of the proximal fibula in a young long-distance runner is reported. Such fractures are rare. The literature is reviewed and diagnosis and treatment are discussed.
The surgical treatment of two cases of bone tumours and one case of a tumour-like lesion are reported in this article. The tumours were resected radically and the massive bone defect or bone cavity were substituted by vascularized free fibula transfer. All of them were cured by early union. Neither atrophy nor non-union between the graft and the recipient bone occurred. Early restoration of function was observed. Our experiences of isolating the graft and the operative procedure are discussed. We believe that this method has prospects not only in the field of treatment of bone tumours but also in the management of bone defects or non-union due to various other causes.
The distinctive radiographic features - megaepiphyses, hypoplastic fibulae, ulnar pseudoepiphyses and brachymesophalangy - in a 14-year-old Japanese boy with mental retardation are reported.
A girl with a "new" variant of mesomelic dysplasia is reported. The disorder is characterized by mesomelic brachymely, especially of the arms, a short ulna, relatively long fibula, brachymetacarpy, minor symmetrical changes at the hands, developmental arrest of the spine, contractures, and micrognathia. The clinical and radiological differential diagnostic features are discussed.
Stress fracture of fibula in athletes and ballet dancers is a well recognised entity. Fibular fractures in children in the first decade of life who are not active in sport or ballet dancing are not well known and often diagnosed as osteomyelitis or malignant bone tumour. This misdiagnosis may be followed by CT, nuclear scan or MR. All these investigations are not necessary and biopsy if performed might even be misleading. The plain X-rays show diagnostic radiographic findings and a misdiagnosis is highly unlikely especially when they are evaluated in the context of clinical findings.
Fibular agenesis/hypoplasia is the most common reduction malformation affecting the long bones. Agenesis of both the fibulae, however, is rare, and its occurrence in four consecutive pregnancies has not been reported so far. We report our experience with one such case.
A case of the adamantinom of the fibula has been reported. The tumor was resected six years ago. The yearly follow-up showed no sign of a relapse or metastases.
We report on 21 cases with combined soft tissue and far reaching bone defects of the lower leg. The bone defects were bridged by the fibula-pro-tibia-operation. In eleven patients the restoration of the full weightbearing leg was achieved. Five patients have to use a supporting walking splint at the end of the medical treatment. In four cases we found fistulas without secretion. Five amputations of the lower leg were unavoidable.
THE PROBLEM: Bilateral congenital absence of the fibula in a 10-year-old boy. A marked valgus malalignment at the left ankle and a foot with three rays caused pain during standing and walking. Ortheses did not help. Therefore, various treatment options were considered such as amputation of the foot, a supramalleolar correction osteotomy, and a tibiotalar arthrodesis. THE SOLUTION: Correction of malalignment and ankle arthrodesis stabilized with an external mini-fixator while sparing the distal tibial physis. SURGICAL TECHNIQUE: Two skin incisions: one on the medial side visualizing the flexor tendons and the neurovascular bundle while sparing the sural nerve and the small saphenous vein. Exposure of the medial malleolus after division of its ligamentous and capsular attachments. Localization of the ankle joint. The second incision on the lateral side. Z-lengthening of the sole peroneal tendon. Opening of the ankle joint at the lateral and anterior aspect. Resection of the articular surfaces of tibia and talus based on a preoperatively made drawing that showed an alignment of the hindfoot with the longitudinal axis of the tibia and the foot in 90 degrees in relation to the leg. Temporary insertion of a Kirschner wire from the sole of the foot into the tibia to maintain the obtained correction. Placement of a mini-fixator: one threaded Kirschner wire crosses the talocalcaneal synostosis, the second the distal tibial epiphysis, and the third one the proximal third of the tibia. Once the frame is mounted, compression of the resection surfaces and slight distraction between the proximal and middle Kirschner wires. RESULT: At the age of 16 years the boy is able to use a regular shoe with an orthotic insert; he is pain-free and can participate in all daily activities. The growth of the tibia has not been affected.