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PubMedDate not supplied

Maxillary augmentation with a microvascularly anastomosed fibula: a preliminary report.

The high resorption rate of nonvascularized bone grafts can be appreciably slowed with the use of endosseous implants and implant-supported prostheses. In cases of extreme atrophy, graft fixation with implants is hardly possible. Especially in the presence of compromised overlying soft tissues, the consolidation of such a graft can also present problems. Improved results can be obtained through use of revascularized bone grafts. Such a method using an anastomosed fibula graft to augment the maxilla is illustrated by a clinical case. After harvesting the graft, the side to come into contact with the alveolar crest is denuded of periosteum, and cuneiform ostectomies are made into the graft to facilitate its adaptation to the maxillary arch. The graft is anastomosed to the facial vessels through an intraoral route and can be placed in such a way as to simultaneously correct any existing crossbite. In contrast to an iliac graft, the implants can be placed bicortically in a fibular graft.

Alveolar Ridge Augmentation↗
PubMed1997

Delayed union following stress fracture of the distal fibula secondary to rotational malunion of lateral malleolar fracture.

We present a case of delayed union following stress fracture of the distal fibula secondary to rotational malunion of a lateral malleolar fracture. The patient underwent operative excision of the nonunion, plating with autogenous iliac bone grafting, and correction of the malrotation of the distal fibular fragment. The fracture healed, and the patient was asymptomatic with full range of motion at follow-up. This report documents an unusual etiology, "external malrotation," for delayed union of a fibular stress fracture.

Adolescent↗
PubMed1976

[Bilateral aplasia of the proximal part of fibula (author's transl)].

Report of an infant with aplasia of the proximal part of the fibula on both sides; by our knowledge the second observation in the literature. Furthermore the infant shows an aplasia of the thyroidea, a coarctation of the aorta, an atrial septal defect and an intraperitoneally situated ascending as well as descending colon.

Abnormalities, Multiple↗
PubMed1997

[Treatment results for ankle fracture with subluxation using bone plates for fixation of the fibula].

The results of surgical treatment of 16 patients (9 females, 7 males) for ankle fracture/subluxation have been presented. Tibio-fibular syndesmosis was reconstructed and the fibula was fixed with an appropriately bent metal plate and screws. Medial malleolus was fixed with a screw or Kirschner wires. Advantages of stable ankle fixation have been discussed. Lateral malleolus fixation facilitates reduction and fixation of the medial one. External immobilization has been abandoned in some patients. The early results of such a treatment are favourable.

Adolescent↗
PubMedDate not supplied

Arthrodesis of the ankle joint with complete removal of the distal part of the fibula: experience with the transfibular approach and three different types of fixation.

In 20 patients the following 3 techniques have been used for ankle fusion, all with a lateral transfibular approach: (1) fibular grafting; (2) lateral removal of the distal fibula and fixation with 3 Blount staples; (3) removal of the distal fibular and fixation with Charnley compression clamps. The compression technique, through a lateral approach, was found to be superior as it avoids section of tendons. Removal of the distal portion of the fibular eliminates the risk of drainage and problems with wound healing due to the presence of a large bone graft immediately underneath the skin. Fusion is obtained more rapidly with the third than the first and second techniques. Pain seems to be related to osteoarthritis of the surrounding joints. The gait pattern depends not only on pain, but also on the position of the foot and on the posterior displacement of the talus. Less osteoarthritis as a result of shorter immoblizaition is the most favorable factor, notwithstanding the longer preoperative period in the third than in the first two methods.

Adult↗
PubMed1998

Osteomyelitis of the fibula due to septic embolism: a rare complication of a graft enteric erosion. Case report.

We report the case of a 70-year-old female who experienced a graft enteric erosion (GEE) three years after a right aorto-femoral bypass. She was treated by right axillo-femoral bypass, removal of the aortic prosthesis and direct aortic suture. The duodenum was stitched up and separated from the aorta by omentoplasty. Bacteriological culture of the removed graft identified Escherichia coli and Peptostreptococcus. Antibiotic therapy consisting of Amoxicillin and Gentamycin was given for seven days. A month later this patient developed a fibula osteomyelitis due to the same germs. She was then treated by surgical excision of the infected tissues and by antibiotics: Amoxicillin, Metronidazole and Gentamycin for one month. This case of embolism into bone due to GEE is a rare complication which indisputably establishes a link between the spontaneously septic cavity of the bowel and bone tissue by way of blood via the interstices of the fabric. The prosthesis may be responsible for blood seeding infection and not only a mere victim. The prosthesis acts as a porous membrane which allows two opposite flows: the passage of blood from graft to bowel and germ migration from naturally septic bowel to blood. When a GEE is encountered, a rigorous management is required to prevent septic embolism. The precise timing of each step of the surgical procedure remains difficult to codify.

Aged↗
PubMed1993

Early loading-related changes in the activity of glucose 6-phosphate dehydrogenase and alkaline phosphatase in osteocytes and periosteal osteoblasts in rat fibulae in vivo.

The tibiae and fibulae of 14-week-old rats were subjected to a single 5 minutes period of cyclic longitudinal loading at 1 Hz. The activity of the enzymes glucose 6-phosphate dehydrogenase (G6PD) and alkaline phosphatase (ALP) in osteocytes and periosteal osteoblasts was measured immediately and 24 h after loading. In osteocytes G6PD activity was increased immediately after loading but returned to control values 24 h later. There was no detectable ALP activity in these cells regardless of loading history. In periosteal osteoblasts G6PD activity was raised immediately after loading and remained higher than controls 24 h later. ALP activity in periosteal cells was unaffected immediately after loading but 24 h later was substantially increased. These findings are consistent with osteocytes and periosteal cells both being immediately responsive to periods of intermittent loading in their adjacent matrices. In both cell types an early feature of this response is an increase in G6PD activity. In osteocytes this response is short-lived, suggesting that it is an early biochemical change associated with strain perception that does not progress to matrix synthesis. The increase in G6PD activity with unaffected ALP levels in periosteal cells immediately after loading is consistent with a similar response. In these cells the increase in G6PD accompanied by increased ALP levels 24 h after loading suggests that the loading-related response progresses to new bone formation.

Alkaline Phosphatase↗
PubMed2000

[New possibilities for reconstructing extensive jaw defects with prefabricated microvascular fibula transplants and ITI implants].

The reconstruction of extensive jaw defects is frequently only possible with microvascular bone flaps. Here we are presenting an operative technique using prefabricated fibular flaps and osseointegrated implants. In a first operation, the fibula is prepared with implants, split skin graft, and a nonresorbable membrane. The jaw defect is reconstructed 6 weeks later and can be treated directly with a prosthesis thanks to osseointegrated implants. The technique is described with reference to 5 patients already operated according to this technique and the initial findings are evaluated.

Adult↗
PubMed2005

Actinomycosis complicating fibula flap mandible reconstruction: a report of two cases.

Two patients undergoing fibula flap mandible reconstruction developed chronic intraoral wounds and salivary fistulae. After initial attempts at salvage, tissue biopsies demonstrated Actinomycosis infection. With antibiotic treatment and debridement, one reconstruction was salvaged while one was lost. Actinomycosis infection should be considered a possible agent in chronic wounds complicating mandible reconstructions with microsurgical flaps.

Actinomycosis↗
PubMed2006

An innovative design for simultaneous reconstruction of complex maxillo-mandibular defects with single free fibula osteocutaneous flap.

Satisfactory reconstruction of complex maxillo-mandibular defect in a single stage has been a surgical challenge. This is particularly because it necessitates a flap which will reconstruct both the maxilla and mandible along with any associated soft tissue defect, mucosa or skin without adding to functional and cosmetic problems for patient and technical problems for the surgeon. Here we describe an innovative design for simultaneous reconstruction of maxilla, mandible, soft tissue and mucosal lining in one stage using a single fibula osteocutaneous flap.

Adult↗
PubMedDate not supplied

Bifurcated femur with a normal tibia and fibula.

Bifurcation of the distal femur is not a common anomaly; there have been only 27 cases of bifurcated femur with tibial hemimelia reported in the literature. This is the first report of a bifurcated femur associated with a normal tibia, fibula, ankle, and foot.

Adolescent↗
PubMed2004

Reconstruction of the pelvic ring using an autologous free non-vascularized fibula graft in a patient with benign fibrous histiocytoma.

BACKGROUND: Benign fibrous histiocytomas (BFH) usually presents as a small benign lesion that predominantly occurs in the skin. Only few cases of BFH arising from bone have been reported, its occurrence in pelvic bones is even rarer. CASE PRESENTATION: A 34-year-old female presented with BFH at a rare anatomical location on both sides of the os ilium which was larger than earlier reported BFH of the bone. Surgical resection was performed successfully including resection of the inner pelvic ring and reconstruction of the linea terminalis using a non-vascularized fibular autograft. At 18 months after tumor resection and reconstruction of the pelvic ring, with interposition of a free vascularized fibula graft patient has an excellent clinical oncological and functional outcome. CONCLUSION: Non vascularized fibular autograft is a useful reconstructive procedure in select patients.

Journal Article↗
PubMed2005

[Congenital pseudoarthrosis of the tibia treated with the free microvascular fibula].

Congenital pseudoarthrosis (CPT) of the lower leg is still a considerable therapeutic problem. There are many surgical and other procedures to manage pseudoarthrosis, but the results are not always satisfactory, unfortunately, and are accompanied by a big number of complications, even limb amputation in some cases. The most complicated surgical procedure is transplantation of the autogenous free microvascular fibula coil which has had the best results momentarily. We are showing a case of a 2.5-year old patient with congenital pseudoarthrosis of the lower leg previously treated unsuccessfully by a conventional surgical method. This is at the same time the first case of such operative treatment of CPT in the territory of Serbia and Montenegro as well as former Yugoslavia. The patient was operated in October 1992.

Child, Preschool↗
PubMed2005

Comparison between meloxicam and transdermally administered fentanyl for treatment of postoperative pain in dogs undergoing osteotomy of the tibia and fibula and placement of a uniplanar external distraction device.

OBJECTIVE: To compare the efficacy of meloxicam administered perioperatively with transdermal administration of fentanyl via a patch placed preoperatively in dogs undergoing orthopedic surgery. DESIGN: Prospective study. ANIMALS: 16 dogs. PROCEDURE: Unilateral or bilateral osteotomy of the tibia and fibula was surgically performed, and a uniplanar external distraction device was placed in each limb. Postoperative pain and lameness were assessed 24, 48, and 72 hours after administration of the first of 3 doses of meloxicam (0.2 mg/kg [0.09 mg/lb], IV, given preoperatively, followed by 0.1 mg/kg [0.045 mg/lb], IV, after 24 hours, and 0.1 mg/kg, PO, after 48 hours) or preoperative placement of a transdermal fentanyl patch (50 microg/h) left in place for 72 hours. RESULTS: No significant differences in total pain scores were detected between groups. Mean +/- SD lameness scores assessed at 24 and 72 hours were lower in dogs in the meloxicam group than dogs in the fentanyl group. Lameness scores decreased with time in a similar manner in both treatment groups. CONCLUSIONS AND CLINICAL RELEVANCE: Perioperative administration of meloxicam or preoperative placement of a transdermal fentanyl patch provided effective and similar postoperative analgesia in dogs undergoing orthopedic surgery. However, because of its anti-inflammatory effects, treatment with meloxicam reduced the degree of lameness and resulted in rapid functional recovery of the limb.

Administration, Cutaneous↗
PubMed2001

Cadaveric fibula, locking plate, and allogeneic bone matrix for anterior cervical fusions after cervical discectomy for radiculopathy or myelopathy.

OBJECT: The authors have previously reported that the results of using cadaveric fibula and locking plate (CF/LP) fusion following anterior cervical discectomy (ACD) for cervical spondylotic radiculopathy and myelopathy are superior to those obtained using autologous iliac crest (AIC) grafts in the short term. The long-term results of using this construct are important in substantiating this improvement. The authors report on 246 consecutive patients (54% smokers) who underwent ACD with CF/LP fusion (175 with allogeneic bone matrix [ABM]) and compare them with 111 consecutive patients in whom AIC fusions (49% smokers) were performed by the same surgeons. METHODS: The study is a retrospective nonrandomized analysis, and chi-square statistics were used. Bone densitometric studies of AIC grafts and CF grafts were performed. A paired t-test was used for statistical analysis of the results. Disease in the group of patients undergoing CF/LP fusion included soft-disc herniation with radiculopathy in 14, soft-disc hemiation with myelopathy in seven, cervical spondylotic radiculopathy in 144, cervical spondylotic myelopathy in 75, AIC graft collapse pseudarthrosis in five, and ACD with no fusion collapse/kyphosis in one. Operations consisted of single-level CF/LP fusion in 142 patients and multilevel CF/LP fusion in 104. Perioperative complications in the CF/LP group included three cases of transient hoarseness. There were no transfusions, infections, neurological injuries, or deaths. The mean hospital length of stay was 1.2 days (28% outpatient and 66% 23-hour stay). The mean follow-up period was 60 months (range 12-94 months). Ten patients were lost to follow up after 1 year. Long-term complications included one traumatic plate fracture and one symptomatic pseudarthrosis with plate fracture. At 1 year and beyond, in 245 (99.6%) of 246 patients radiographically documented fusion with no motion at the fused level on flexion-extension films was demonstrated. There was no kyphosis, no symptomatic screw plate backout, and no CF/LP graft collapse (100% in the ABM group). In the 111 consecutive patients with AIC fusions, however, there was a 17% graft-related complication rate. There were significantly fewer graft-related complications in the CF/LP group (p < 0.001). There was no difference in neurological outcome for any of the groups. In the groups undergoing single-level ACD there was a significantly greater chance of complete relief of neck pain CF/LP fusion compared with those undergoing AIC fusion (p < 0.02). There was a significantly greater chance of AIC collapse with the passage of time compared with CF graft (p < 0.02). Time until return to work was shorter for the CF/LP group by 5 to 6 weeks (p < 0.02). There was a higher rate of radiographically documented pseudarthrosis in the AIC group (p < 0.006). The mean bone densitometry for the CF/LP group was 0.7 g/cm2, significantly greater than that of the AIC group, which was 0.2 g/cm2 (paired t-test p < 0.001). CONCLUSIONS: When fusion is necessary following ACD, the results of CF/LP fusion are significantly superior in the first 5 years after surgery compared with those for AIC fusions. It remains to be determined if demineralized ABM has a significant effect in enhancing fusion.

Adult↗
PubMed2001

[Radial forearm and fibula free flap reconstruction after radical resection of head and neck malignancies]

The incidence of head and neck cancer has been rapidly increasing in Hungary during the last decade. Most of these tumors are discovered in advanced stage, consequently, surgical removal of the tumor results in large complex defects in the soft tisses and bone elements of the face and neck. For optimal anatomical and functional reconstruction we perform free flap transfer in increasing number of cases. Between December 1993 and March 2001 in the Head and Neck Surgery Department of the National Institute of Oncology the defects after resection of head and neck tumors were reconstructed with free flaps in 85 cases. Radial forearm flap in 64 cases, fibula osteoseptocutaneous flap in 14 cases were used. In 87% of the patients the postoperative period was uneventful, the surgical complications were not more numerous than following traditional reconstructions. The average duration of operations became shorter by 2.5 hours during the last two years than before. In most of the cases we achieved good functional and esthetic results. The quality of life of the patients was excellent in 14%, almost normal in 73% and bad with serious problems of social life in 13%. It is surprising that there was no significant difference between the survival of neck node positive and negative patients. In our practice the replacement of large defects in the head and neck region with free flaps is a reliable and useful method for reconstruction.

Journal Article↗
PubMed2001

Fixation methods in mandibular reconstruction using fibula grafts: A comparative study into the relative strength of three different types of osteosynthesis

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. Copyright 2000 John Wiley & Sons, Inc. Head Neck 23: 1-7, 2001.

Journal Article↗
PubMed1995

Adjunct fibula strut bone graft in resurfacing hip arthroplasty.

Femoral neck fracture following surface replacement is a reported complication. Adjunct autogenous fibula strut bone grafting has been proposed as a means of reducing or eliminating this occurrence. This paper reports the long-term follow-up of two cases. One patient did well for 9 years prior to sustaining a traumatic femoral neck fracture while intoxicated; the second patient continues to do well 8.5 years postoperatively. While definite conclusions cannot be drawn, these two patients represent our longest-clinical successes using surface replacement arthroplasty.

Adult↗