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This paper presents the case of osteogenic sarcoma, situated in fibula of 14-year-old boy. The X-ray picture of this tumor was typical of unicameral cyst, but histopathological examination showed traits of osteosarcoma. Only magnetic resonance suggested the presence of malignant neoplasm.
The authors present a case of acquired, untreated pseudarthrosis of the tibia which resulted in adaptation to the weight-bearing function by the fibula. The case described shows the adaptation abilities of the bone tissue which, when subjected to unusual loading, undergoes the necessary reconstruction.
BACKGROUND: Bone staples made of a nickel titanium alloy exert dynamic compression, require little dissection, and may provide an alternative to conventional fixation in mandibular reconstruction with a free vascularized fibula graft. METHODS: To evaluate its stability relative to conventional methods of fixation with interosseous wires or miniplates, an in vitro model using beech dowels was developed. Torsional stiffness and strength and compression stiffness and strength were examined. RESULTS: The compression test results showed that maximum strength of interosseous wires is significantly less than memory staples, which in turn are significantly weaker than titanium miniplates. Miniplates are significantly the most rigid form of fixation. Torsional testing showed no significant difference in strength between staples and miniplates and only a marginal difference in elasticity. Interosseous wires show a rapid decrease of strength and rigidity during torsional stress. CONCLUSION: When considering interosseous wires the least and miniplates the most stable form of fixation by which bone healing can occur, memory staples can provide enough stability to ensure consolidation.
Devascularized bone grafts are pieces of dead bone and they simply serve as scaffolds for new bone to grow and fill the gap, taking a long time when they succeed in doing so. In contrast, vascularized grafts being living tissues have short healing time, great vitality and strong infection-resisting capacity. We report here the successful use of vascularized grafts of the lower end of fibula for fusing the ankle in five leprosy patients.
AIM: Determination of the range of regional blood flow and fluoride influx during normal incorporation of revascularized fibula grafts used for mandibular reconstruction. Evaluation, if healing complications are preceded by typical deviations of these parameters from the normal range. Assessment of the potential influence of using "scaled population-derived" instead of "individually measured" input functions in quantitative analysis. METHODS: Dynamic F-18-PET images and arterialized venous blood samples were obtained in 11 patients early and late after surgery. Based on kinetic modeling regional blood flow (K1) and fluoride influx (Kmlf) were determined. RESULTS: In uncomplicated cases, early postoperative graft K1--but not Kmlf--exceeded that of vertebrae as reference region. Kmlf values obtained in graft necrosis (n = 2) were below the ranges of values observed in uncomplicated healing (0.0113-0.0745 ml/min/ml) as well as that of the reference region (0.0154-0.0748). Kmlf values in mobile non-union were in the lower range--and those in rigid non-union in the upper range of values obtained in stable union (0.0211-0.0694). If scaled population-derived instead of measured input functions were used for quantification, mean deviations of 23 +/- 17% in K1 and 12 +/- 16% in Kmlf were observed. CONCLUSIONS: Normal healing of predominantly cortical bone transplants is characterized by relatively low osteoblastic activity together with increased perfusion. It may be anticipated that transplant necrosis can be identified by showing markedly reduced F- influx. In case that measured input functions are not available, quantification with scaled population-derived input functions is appropriate if expected differences in quantitative parameters exceed 70%.
The fibula osteoseptocutaneous free flap is ideal for reconstruction of composite mandible defects. Osseointegration is possible and advantageous. Primary osseointegration of dental implants is a safe and reliable procedure in selected groups of patients, promoting early total oral rehabilitation with restoration of both function and cosmesis. Further studies are necessary to assess the specific indications for osseointegration teeth in patients with malignant tumors and in those patients who have received radiation therapy.
OBJECTIVE: To study the traumatic mechanism and clinical treatment of Maisonneuve fracture. METHOD: 19 of 25 patients (6 - 60 months, average 16.8 months) were followed up. 11 patients were operated on and 8 were treated conservatively. Of the 25 patients, 8 had MRI. Osteotomy and serial section of the interosseous membrane (IOM) on fresh cadaveric specimens were doc carried out to observe the diastasis on stress mortise view. RESULT: Functional rehabilitation of the ankle joint: in 11 operative cases, 8 showed good results and 3 fair. In 8 conservative cases, 3 showed good results, 2 fair and 2 poor. MRI: IOM was ruptured in a range 3 - 8 cm proximal to the tibial plafond in the 8 cases. No IOM rupture was found at the high fibular fracture level. Fresh cadaveric experiment: fixation of the medial side alone can not control the syndesmotic diastasis on the artificial Maisonneuve fracture model made on cadaveric specimen. CONCLUSION: The injury level of the IOM during Maisonneuve fracture may not be consistent with the high fibular fracture. The limited external rotation of the fibula during injury by the superior tibio-fibular syndesmosis comprise to the high level fibular fracture. ORIF with syndesmotic fixation is recommended for the treatment.
Intramedullary nailing of thirty acute displaced open fractures of the tibia and fibula resulted in union with only one superficial infection. The low incidence of sepsis is attributed to the use of the curved malleable Hodgkinson tibial nail which requires no reaming, renders the operation less difficult and traumatic, and interferes minimally with bone vascularity. Fibular nailing was an effective means of stabilizing nine of the twelve fractures close to the ankle joint.
Congenital longitudinal deficiency of the fibula presented two major problems in management: severe shortening of the limb and equinovalgus deformity of the ankle and foot. When the deformity was severe, our attempts at reducing the deformities of the foot and ankle with soft-tissue procedures and our attempts at achieving limb-length equality with various lengthening procedures were unsuccessful. Our best results in these patients were achieved with an early Syme amputation. The pattern of the deformity and the determination of the growth inhibition factor in the involved limb now enable us to make an early estimate of the deformity and plan appropriately. Syme amputation is definitive and allows the patient to have nearly normal function of the limb and a prosthesis of excellent appearance.
A case of a 24-week-old fetus of non consanguineous parents with an ultrasonographic diagnosis of a short right femur, ipsilateral agenesia of the fibula and a twisted right foot is described. Cordocentesis revealed a normal 46XY karyotype. The parents were informed on treatment options and after psychological counselling they decided to undergo an abortion. Post mortem examination confirmed the diagnosis of a severe right limb malformation.
The authors have studied 62 cases of aplasia of hypoplasia of the fibula. They note that developmental abnormalities affect the whole of the lower limb. They describe the evolution of the bony deformities and of anomalies of the soft tissues. They conclude that discrepancy in limb length is the major factor in the prognosis and that it increases uniformally. Surgery is indicated even when a definitive prosthesis is planned. The possibility of leg lengthening must be approached with caution.
The long term fate of the fibula in an intra-osseous site is still a matter of debate. Since the procedure of free fibular grafting for neglected femoral neck fractures was routinely done at our institute, we were able to observe the serial changes in 37 cases with an average 8.9 years follow-up. Graft incorporation was not consistent in the 4 to 10-year postoperative period, but in cases with more than 10 years follow-up, a major portion of the graft got incorporated into the host bone. A classification system for the incorporated grafts is suggested. The presence of avascular necrosis seems to initially hinder graft incorporation, but if the bone revascularises, graft incorporation proceeds at a comparable rate. This study shows that cortical bone gets well incorporated into host cancellous bone and helps to reconstitute the neck in cases of femoral neck nonunions.
Mandibular reconstruction in cases of complex muco-cutaneous defects is a challenge for head and neck surgeons. Here, we report the case of a patient who showed an oro-facial defect including bone, skin and mucosa. We decided to use a double skin paddle fibula osteocutaneous free flap for the reconstruction. Identification and preservation of the septo and musculocutaneous perforators vessels to the skin is the clue step to ensure flap vitality. In this situation mucosal and cutaneous reconstruction is possible using a folded skin paddle. We also discuss the reconstructive options for this kind of defects.
Schwannoma, or neurilemmoma, is a benign nerve sheath tumor most commonly located in the soft tissue. Occasionally, Schwannomas involve osseous structures. Involvement of two adjacent long bones was not found in a review of the English language medical literature. We present the case of a neurilemmoma affecting both the distal fibula and tibia. Although rare, intraosseous neurilemmoma should be included on the differential diagnosis of painful, radiographically benign-appearing lesions arising in long bones.
This patient report describes the secondary reconstruction of a hemimandibular and condylar defect and the dental restoration of a 56-year-old woman who had been subjected to radical ablative surgery 30 years earlier to remove a tumor. In the first phase, a fibula free flap was used in combination with a total TMJ prosthesis for the reconstruction of the hemimandible and condyle. Secondly, 3 endosseous implants were placed in the residual mandible. These implants were used to support an overdenture prosthesis that has remained in continuous function for a period of 2 years.
If the correct treatment is applied, growth disturbances following epiphyseal fractures of the distal tibia are rare. Even if the prognosis is good after the correct treatment of epiphyseal fractures of the distal tibia, the parents and child may have to be informed about growth disturbances. Most frequent is a varus deformity after asymmetric closure of the medial growth plate. If at least 2 years of growth can be expected, a callus resection according to Langenskjöld is indicated. If this procedure fails, the ideal timing for a correction is the end of the growth. Imminent contractures can be an indication for early correction even if a recurrent deformity can be expected. An open-wedge osteotomy permits all three procedures to be carried out: callus resection, axis correction and leg-length correction. If an incongruence of the joint is present, the closed wedge technique using an external fixator is indicated; correction of the leg length can be postponed. Joint incongruence reacts well to axis alignment. The pre-arthrotic joint can remain free of symptoms for years. We never encountered epiphyseal fractures of the distal fibula, but we did see one case of deformity of the ankle joint as a result of closure of the proximal fibular growth plate.
The case presented of a rare injury of the left knee joint underlines the necessity for meticulous examination. We report on isolated dislocation of the head of the fibula in a 25-year-old football player; the diagnosis and therapy for this rare injury are presented.
Tendoachilles tenodesis to the fibula was performed in postpolio patients to improve their gait. The charts of 48 patients with 52 tenodeses were reviewed. The mean follow-up was 5.5 years. Gait improved in one-third. When the hindfoot was stabilized, gait improved in 40% of the patients, but when it was not stabilized, only 22% improved their gait. Excessive equinus developed in 18 patients, all of whom were less than age 12 years when operated. We conclude that it is reasonable to use this procedure to improve the gait of postpolio children with flail lower extremity, provided the hindfoot is stabilized.