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We report four patients with unilateral bowing of the lower leg, affecting only the fibula. The bone is too long with anterolateral curvature of the distal third. Because of its regressive course and the absence of cutaneous involvement, this newly described entity can be distinguished from other forms of bowing of the leg.
We report eight patients with prominent cystic changes in the head of the fibula. Seven of these had osteoarthritis of the adjacent knee, and five had evidence of local deposition of calcium pyrophosphate dihydrate crystals. A radiographic survey of 470 knees in 254 patients with osteoarthritis suggested that such cysts are rare, but should be considered in the differential diagnosis of such changes before expensive or invasive investigations are performed.
Limb salvage after loss of bone and soft tissue may require many operations to obtain soft-tissue cover and bony continuity. We describe a fibula-flexor hallucis longus osteomuscular flap which can provide both soft tissue and bone in a single stage. The flap is based on the peroneal vessels and is covered by a split-thickness skin graft. We report the results in five patients with an average bone defect of 8.3 cm and soft-tissue and skin loss. All regained a normal gait on the donor side; four had clinical and radiological union with excellent soft-tissue cover, but one required later amputation due to diffuse coagulopathy. The flap provides free vascularised bone with muscle cover. It has a dependable, long pedicle with minimal morbidity at the donor site, and allows monitoring of the vascularity of the fibular graft.
A giant cell tumour is a primary lesion of bone of intermediate severity. Its histogenesis is unclear. In a few cases pulmonary metastases have been described. Multiple skeletal metastases in the absence of sarcomatous change have been observed. We present a case report of a 25-year-old woman with a recurrent giant cell tumour of the distal fibula. After a second recurrence and six years after the initial diagnosis, she rapidly developed multiple bony metastases. The outcome was fatal.
Dental implant treatment is an indispensable portion of oral rehabilitation in patients who are to undergo reconstructive surgery following the removal of an oral cancerous lesion. However, ideal dental implant treatment cannot be achieved easily in patients who have undergone mandibular reconstruction with a free vascularized flap, usually because of the limited length, height, and width of the bone graft. Shorter implants (< 10 mm in length) therefore are occasionally used in vascularized fibula graft sites. In such cases, however, shorter implants tend to be overloaded, thereby endangering its longevity. In this article, we discuss how a magnetic abutment system was introduced for such a patient. This was designed to discourage overloading of the mandatory short implants. The outcome was successful without overloading 1.5 years after the placing of the mandibular overdenture.
A prospective, randomized trial was undertaken to determine the rate of complications after the use of a tourniquet during open reduction and internal fixation of simple, closed fractures of the distal part of the fibula. Forty patients were operated on with use of a tourniquet (Group 1) and forty patients, without use of a tourniquet (Group 2). The average duration of the operation was significantly different between the two groups (41 +/- 9 minutes for Group 1 compared with 53 +/- 12 minutes for Group 2 [p = 0.026]). There were more complications in the patients in Group 1, two of whom had an isolated deep-vein thrombosis of the calf. The wound was possibly infected in eleven patients (seven in Group 1 and four in Group 2 [p < 0.05]) and frankly infected in three patients, all in Group 1 (p < 0.05). The plaster-of-Paris cast needed to be changed in three patients from Group 1. The patients in Group 1 returned to work an average of one week later than those in Group 2. The mean duration of follow-up was eighteen months (range, nine to thirty-two months). Given the lower prevalence of postoperative complications and the shorter time to recovery for the patients in Group 2, we believe that it is justified not to use a tourniquet in the operative treatment of simple, isolated fibular fractures.
We reviewed the results of early amputation and prosthetic fitting in twenty-five children (thirty-one extremities) who had longitudinal deficiency of the fibula and were managed between 1977 and 1992. The median age at the time of the initial operation was thirteen months (range, eight months to nine years and eight months). The median duration of follow-up was eight years and ten months (range, two years and six months to sixteen years and eleven months). A Syme amputation was performed on fifteen extremities (thirteen children), and a modified Boyd amputation (which included resection of the distal tibial physis) was performed on sixteen extremities (thirteen children). (One child had a Syme amputation on one side and a Boyd amputation on the other and is thus included in both groups). In twenty-seven extremities, simultaneous excision of the fibular anlage was performed to prevent the development of a deformity secondary to the potential tethering effect. In twelve extremities, a diaphyseal osteotomy of the tibia also was performed to correct tibial bowing and to improve the mechanical alignment of the extremity. At the time of follow-up, the patients who had had a Syme amputation had more problems related to reformation of the calcaneus, instability of the heel pad, prosthetic suspension, and excessive length of the residual extremity. The modified Boyd amputation improved the function of the heel pad and the prosthetic suspension and provided the optimum length of the residual extremity. We also found that an early diaphyseal osteotomy of the tibia to correct severe bowing improved prosthetic fitting. This study did not support the concept that early resection of the fibular anlage or a diaphyseal osteotomy of the tibia prevents the development of hypoplasia of the lateral femoral condyle and associated genu valgum deformity.
Stress fractures (two in the calcaneus and four in the distal tibia) occurring distal to the site of a healing fracture of the tibia or fibula were discovered in five patients. Three of these fractures were identified radiographically at the time of their occurrence, and three were identified only after retrospective review of the radiographs of 74 patients with previous tibial or fibular fractures. Three of the patients were less than 10 years old. All five patients had disuse osteopenia and recently had begun weight-bearing. Four patients had healing of their acute fractures with angulation or displacement. Stress fractures can easily be overlooked on radiographic studies in this setting and may be a source of pain that mistakenly can be attributed to malunion or nonunion. Stress fractures should be considered in patients with fractures of the lower extremity, particularly those who experience new or persistent pain or discomfort.
Osteofibrous dysplasia (ossifying fibroma of long bone) is an uncommon disorder of bone affecting the tibia and, rarely, the fibula of children and adolescents. It has been delineated from monostotic fibrous dysplasia, from which it can be distinguished by its radiological and histological characteristics and by its clinical course. We report 11 patients with osteofibrous dysplasia whose ages ranged from 10 months to 22 years. Four presented with a pathological fracture and in 2 a pseudarthrosis developed. A circumscribed area of intracortical lucency and expansion in the diaphysis is the characteristic radiological finding. Histologically there is a similarity to fibrous dysplasia but the trabeculae are lamellar or have a lamellar surface and most show osteoblastic rimming. Treatment may be difficult but more recent experience strongly favours a conservative approach wherever possible.
The authors present a case of fracture dislocation of the ankle with the fibula entrapped behind the tibia--Bosworth's fracture. It is often unrecognized as such because it is so rare and because radiographs are not correctly interpreted. A stable reduction can be obtained by closed treatment when promptly recognized.
We treated 12 patients with a primary sarcoma of the tibia by resection and centralization of the ipsilateral vascularized fibula with preserved vascularization. The reconstruction was combined with an allograft. The median bone defect after tumor resection was 14 (8-24) cm. The anastomosis between the allograft and the recipient bone was stabilized by a plate or screws or Kirschner-wires. To reconstruct the soft tissues, 8 patients underwent a gastrocnemius plasty and 2 patients a free vascularized flap of the latissimus dorsi muscle. The mean follow-up period was 2.5 (2-3.5) years. 2 years after implantation, union > or = 75% of the anastomosis area was noted in 10 patients. A deformity or fracture of the distal junction occurred in 7 patients with a screw or Kirschner-wire fixation. Neither deformity nor fracture developed in the 5 patients with plate-fixation.
A case of bilateral fractures of the upper third of the fibula caused by indirect trauma is reported. There was no associated ankle or knee injury. A probable mechanism of injury is discussed.
This study reviewed operative treatment of Maisonneuve fracture of the fibula in 26 patients. Operative treatment consisted of restoration of the fibular length, repair of the lateral and medial ankle ligamentous structures, and placement of one or two suprasyndesmotic screws. After average follow-up of 6.4 years, the clinical results were satisfactory in 23 (88.4%) patients. Operative treatment is the treatment of choice for Maisonneuve fractures, and a satisfactory outcome may be anticipated after appropriate management of any associated bony and syndesmotic injuries.
BACKGROUND: High energy ankle injury can be devastating. Fibula loss proximal to the syndesmosis is a management challenge. The aim of this paper is to show that simple fusion of the floating lateral malleolus to the tibial plafond can restore the ankle mortice integrity. METHOD: A case report of a patient that had spontaneous fusion of the lateral malleolus to the lateral tibial plafond after a high energy injury and subsequent sepsis. RESULT: Uneventful union of the lateral malleolus to the lateral tibial plafond. CONCLUSION: Ankle fusion, bone lengthening procedures are time consuming and costly. A simple fusion of the lateral malleolus to the tibial plafond will restore stability to the ankle joint.
We present a case of osteosarcoma arising in an osteochondroma of the right fibula in a 30-year-old woman. The available radiographic studies of the lesion were not suggestive of malignant transformation. The lesion and underlying bone were excised. Histologic examination showed a conventional high-grade osteoblastic osteosarcoma that focally eroded the fibrocartilaginous cap. The patient received postoperative chemotherapy and shows no evidence of disease 27 months following operation. The occurrence of osteosarcoma in an osteochondroma is an extremely rare event, and only a few cases are on record in the literature.
The syndrome caused by congenital absence of the fibula has a number of pathologic abnormalities frequently associated with it, which are illustrated by the case reported. Postsurgical therapy on the involved extremity should take into account the patient's lack of joint motion within the tarsal region. With this in mind, special shoes or accommodative insoles, alone or in combination, should be prescribed in order to facilitate an increase in weightbearing activity with minimal discomfort.
The anatomical region "laterodorsal calf" with the fibula, the flexor muscles and the overlying skin served by the peroneal vessels, is a suitable donor region particularly for combined microsurgical transfer of bone and soft tissue. In a five and a half year period, 59 reconstructions, 39 (66%) with and 20 (34%) without soft tissue transfer, were performed. The versatility and the functional and esthetic results after osseous, osteocutaneous, osteomuscular and osteomyocutaneous tissue transfer are presented.
The surgical treatment of advanced oral cavity cancer presents a difficult reconstructive challenge since tumor resection can result in "through and through" bone and soft tissue defects. Reconstruction is essential for an acceptable aesthetic outcome, as well as functional oromandibular rehabilitation. The advent of microvascular free tissue transfer now allows immediate reconstruction of these large composite resections, and offers significant advantages over more traditional techniques. Success rates approach 90%-95% at most large centers. In this article, we describe the challenging decisions faced by clinicians treating these patients, and discuss our reconstructive method of choice, the fibula osteomyocutaneous free flap.