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PubMed2005

Risk factors for fracture of the shafts of the tibia and fibula in older individuals.

A case-control study to identify risk factors for fracture of the shafts of the tibia and fibula among persons 45 years of age and older was undertaken in five Northern California Kaiser Permanente Medical Centers during 1996-2001. One hundred seventy-nine cases of newly diagnosed fracture of the tibia/fibula shaft and 2,399 controls sampled from the membership lists of the same five medical centers were included. Information on potential risk factors was obtained by a standardized questionnaire administered by trained interviewers. The number of previous fractures was associated with an increased risk [adjusted odds ratio (OR) (95% confidence interval)=1.49 (1.09-2.03) per previous fracture]. Attributes known or thought to be associated with protection against loss of bone mass, including high body mass index [adjusted OR=0.82 (0.69-0.97) per 5 kg/m2 increase], having ever used thiazide diuretics or water pills for at least 1 year [adjusted OR=0.62 (0.38-1.02)], and current use of menopausal hormone therapy among females [adjusted OR=0.84 (0.53-1.32)] tended to show decreased risks. Factors generally associated with lower bone mass, such as current cigarette smoking [OR=1.55 (1.01-2.39)] and, to some extent, lack of physical activity [OR=1.31 (0.87-1.96) for the lowest quartile compared to the upper three quartiles], tended to demonstrate increased risks. The number of falls in the past year and risk factors for falls were not associated with tibia/fibula shaft fractures, and indicators of health status were weakly and inconsistently associated with risk. Thus, this study suggests that risk factors for low bone mass, but not health status or risk factors for falls, may be important in the etiology of fracture of the shaft of the tibia/fibula in older individuals.

Accidental Falls↗
PubMed2004

Differentiated adamantinoma of the fibula: a rhabdoid variant.

A benign- appearing osteolytic lesion surrounded by a sclerotic rim was found in the upper fibula of a 25-year-old man. Based on histological features the definitive diagnosis of osteofibrous dysplasia-differentiated adamantinoma was made. The correct histological diagnosis of differentiated adamantinoma depends on factors such as the uniform predominance of an osteofibrous dysplasia-like pattern, and scattered epithelial elements positive for cytokeratin and vimentin. In this case the scattered epithelial cells had abundant eosinophilic cytoplasm and resembled rhabdoid elements, but immunohistochemistry proved their epithelial origin.

Adult↗
PubMed2004

Cementoma of the fibula: imaging findings with histopathologic correlation and review of the literature.

Bone tumors containing fibrous tissue and cementum-like spherules are typically found in the maxilla and mandible. However, such lesions are extremely infrequent in the long bones. We report the complete radiologic assessment of a cementoma of the fibula in a 42-year-old man. We also correlate the findings with data provided by histopathologic analysis, and review the English-language literature on tumors of long bones that may contain cementum-like material.

Adult↗
PubMed2005

Hemangioendothelioma with an epithelioid phenotype arising in hemangioma of the fibula.

The classification of certain vascular bone tumors that show an epithelioid cytologic appearance remains confusing, with overlap in features of epithelioid hemangioma, hemangioendothelioma and epithelioid hemangioendothelioma. Radiographs of a 27-year-old woman who presented with ankle pain showed an expanded lytic-sclerotic lesion in the distal left fibula. Magnetic resonance imaging showed an intramedullary lesion with a small lateral intracortical component. The lesion was hypo- to isointense to muscle on T1-weighted images and heterogeneously hyperintense on T2-weighted images. Initial incisional biopsy was inconclusive. Open biopsy showed hemangioendothelioma with epithelioid morphology, and the lesion was completely resected with reconstruction using a peroneal fibular rotation graft. Examination of the resected specimen showed focal hemangioendothelioma with an epithelioid phenotype arising in a hemangioma. This case illustrates the difficulty and pitfalls of making the correct diagnosis on the basis of a small biopsy specimen.

Adult↗
PubMed2000

Intraosseous glomus tumor of the fibula.

Glomus tumor is a rare, benign vascular tumor and intraosseous glomus tumor, which arises primarily within bone, is even rarer. Fewer than 20 cases have been reported in the literature. We present the case of a 34-year-old woman with glomus tumor primarily in the midshaft of the fibula that radiologically mimicked chondromyxoid fibroma, aneurysmal bone cyst or adamantinoma, together with a review of other reported cases.

Adult↗
PubMed1997

Intraosseous neurilemmoma of the fibula.

We present a case of intraosseous neurilemmoma of the fibula in a 56-year-old woman. The case showed the typical radiographic appearance except for the presence of spotted calcifications that mimicked a cartilaginous tumor. Enhanced MR images revealed the heterogeneity of the tumor, which consisted of Antoni type A and B tissue.

Bone Neoplasms↗
PubMed2001

Anatomical aspects of biopsy of the proximal fibula.

The relationship between the peroneal nerves and the anatomical structures near the fibular head were studied in 20 cadavers. It was the purpose to define the boundaries of a "safe" area when performing a biopsy of the fibular head. The distances between the proximal end of the fibular head and the deep peroneal nerve (26+/-0.32 mm) and the intermuscular septum (15+/-0.19 mm) were measured, as well as the angle between the deep peroneal nerve and the fibula as seen in the A-P view (23.5+/-3.5 degrees). We considered that biopsies should be performed with an anterolateral approach in the safe area formed by the fibular head and the deep peroneal nerve in the anterior compartment.

Biopsy↗
PubMed2002

Ventral cervical fusion at multiple levels using free vascularized double-islanded fibula - a technical report and review of the relevant literature.

Reconstruction of the cervical spine using free vascularized bone flaps has been described in the literature. The reports involve either one level or, when multiple levels, they describe en bloc resection and reconstruction. Stabilization of different levels with a preserved intermediate segment with a single vascularized flap has not been described. We report on the case of a 55-year-old man, who had been operated several times using conventional techniques for cervical myelopathy and instability, who presented to us with severe neck pain. Diagnostic procedures showed pseudarthrosis of C3/4 and stress-overload of the C3/4 and C5/6 segments. The C4/5 fusion was adequately rigid, but avascular. We performed anterior cervical fusion at the C3/4 and C5/6 levels with a vascularized fibula flap modified as a double island. The rigidly fused C4/5 block was preserved and vascularized with the periosteum bridging the two fibular islands. The method and technique are described in detail. Fusion was adequate. Donor site morbidity was minimal and temporary. The patient is symptom free to date (25 months). The suggested method provides the possibility of vertebral fusion at different levels using a single vascularized flap. The indications for this procedure are (1) repeated failure of conventional methods, (2) established poor bone healing and bone non-union with avascular grafts and (3) a well-fused or preserved intermediate segment. The relevant literature is reviewed.

Bone Plates↗
PubMed2001

Bilateral tibia and fibula fractures in a patient with rheumatoid arthritis.

A 52-year-old woman with rheumatoid arthritis treated with low-dose steroids developed bilateral distal tibia and fibula fractures over a 15-month period. Her bone density was within osteopenic levels. Such fractures are an unusual but increasingly recognised complication of rheumatoid disease and its treatment, although there is often diagnostic delay. Bilateral fractures are particularly rare. A high level of clinical suspicion is required for early diagnosis.

Adrenal Cortex Hormones↗
PubMed1990

Mandibular reconstruction using vascularised fibula.

The osteocutaneous fibula flap has been used to reconstruct large segments of mandible in cases following ablation for cancer or radionecrosis. The bone can be cut to the appropriate shape and the fasciocutaneous flap may be used simultaneously to provide oral cavity lining or skin cover. The technique is described and its successful use in seven patients is reported with details of the complications encountered.

Adult↗
PubMed1990

Donor site morbidity following osteocutaneous free fibula transfer.

Nine patients who had undergone free fibula transfer were reviewed to determine the incidence of donor site complications. Problems identified included distal oedema, cold intolerance, sensory loss and weakness. However, the functional deficit was not great and most patients were not troubled by their symptoms. More serious potential complications from raising this flap are considered.

Adult↗
PubMed1990

Acute plastic bowing fractures of both the tibia and the fibula in a child.

A case of acute plastic bowing fractures of both the fibula and tibia in a child is presented. This type of fracture has never been reported in the tibia, but has now been reported in all the major bones of the limbs. The clinical picture is described, and the indications for treatment discussed. In case of doubt, radiographs should be taken of the opposite limb, if the clinical picture suggests a bowing fracture.

Bone Development↗
PubMed1993

Tibial shaft fractures with an intact fibula.

The effect of several factors on the healing rates of tibial shaft fractures with an intact fibula were examined. Those found to adversely affect healing rates included: 1. Open fractures; 2. Oblique or comminuted fractures; 3. High-velocity injuries; 4. Angulation in the sagittal plane; 5. Displacement. No other factors examined were associated with delayed union. The predictive values for delayed union are estimated for each of these factors in isolation and in combination.

Adolescent↗
PubMed1985

Fractured fibulae in broiler fowls.

Fibular diaphyseal fractures were identified bilaterally or unilaterally in 15 broilers aged between 13 and 105 days. Incomplete cortical defects were also identified on radiographs in a further 8 birds. Fractures and incomplete defects always occurred at the Tuberculum M. iliofibularis of fibulae. The character of bone at this site differed from bone elsewhere in the diaphysis. Following fracture, cartilaginous callus united the diaphyseal segments and pseudarthrosis or fibrous non-union were common sequelae. The concept that fibular fractures in broilers are always a consequence of abnormal proximal tibiotarsal curvature is not supported by this study. It is suggested that differential growth of the paired crural bones is of primary importance.

Aging↗
PubMed1991

The vascularized fibula graft in mandibular reconstruction.

The use of a vascularized graft from the fibula for mandibular reconstruction is presented. The great strength, pliability, and long vascular pedicle that characterize such grafts make them particularly suitable for this type of repair. The results in six cases were highly satisfactory. Masticatory function was well restored, without alteration of the facial contour, and with minimal sequelae at the donor site.

Adult↗
PubMed2006

Stress fractures of the medial malleolus and distal fibula.

Stress fractures of the medial malleolus and distal fibula are rarely encountered. They typically affect the athletic and running population and manifest the usual signs and symptoms of stress fractures. Axial and torsional forces, muscular contractions, and alignment are believed to play a role in their development. Plain radiographs are often initially nondiagnostic. The diagnosis can be confirmed with radionuclide bone scanning or MRI. Most injuries are amenable to nonsurgical management. An operative intervention for athletes with medial malleolar stress fractures has been advocated under certain circumstances.

Adult↗
PubMed2005

Free vascularized fibula for the treatment of traumatic bone defects and nonunion of the forearm bones.

Eighteen infected nonunions and segmental defects of both the radius and ulna which had failed to resolve with conventional treatment were treated with a free vascularized fibular graft to restore radial, but not ulnar, continuity. In three patients there was destruction of the wrist joint and in two destruction of the elbow. The time from injury to referral ranged from 4 weeks to 3 months. The ipsilateral fibula was used as an osseous or osseocutaneous free flap to reconstruct the radius. All fractures united with good soft-tissue healing and resolution of infection. One patient required additional cancellous bone grafting. The mean period required for radiographic bone union was 4 months. Reconstruction of only the radius provided a stable forearm with a reasonable range of forearm rotation.

Adult↗
PubMed2006

Surgical management of ameloblastoma in the mandible: Segmental mandibulectomy and immediate reconstruction with free fibula or deep circumflex iliac artery flap (evaluation of the long-term esthetic and functional results).

PURPOSE: Ameloblastoma is responsible for 1% of all the oral and maxillomandibular cysts and tumors. It is odontogenic in origin and benign in nature but it has a high percentage of local recurrence rate and possible malignant development when treated inadequately. With the advancement of craniofacial surgical techniques, use of free flaps for mandibular reconstruction, and dental rehabilitation (such as osseointegration), the segmental mandibulectomy and immediate reconstruction with free flaps are beginning to be used more effectively for the treatment of the mandibular ameloblastoma. The aim of this article is to evaluate the clinical results of the patients with mandibular ameloblastoma who were treated with segmental mandibulectomy and immediate reconstruction with free flaps. PATIENTS AND METHODS: We present 11 patients who had segmental mandibulectomy and immediate reconstruction with free deep circumflex iliac artery or fibular flap for treatment of mandibular ameloblastoma. The average age of the patients was 25.4 years (range, 18-38 years). The patients were followed up for a mean of 29.3 months (range, 17-38 months). The functional and esthetic results were also evaluated by using a questionnaire in the long term. The questionnaire consisted of questions addressing oral continence, diet, social activities, speech, and facial appearance. RESULTS: All flaps survived totally. Recurrence was not detected during the follow-up period. It was found that all patients had good esthetic and functional results after immediate reconstruction. The social activities of patients also were not affected after treatment. CONCLUSIONS: We experienced that segmental mandibulectomy with safe borders and immediate reconstruction with free fibula flap or deep circumflex iliac artery (DCIA) flap is an ideal treatment method for mandibular ameloblastoma. The functional and esthetic results are also detected as very satisfactory for the patients.

Adolescent↗