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At least 145 records · Page 8Linked to original sources
PubMed1995

Normal maturing distal tibia and fibula: changes with age at MR imaging.

PURPOSE: To describe the normal appearance of the maturing distal tibia and fibula at magnetic resonance (MR) imaging. MATERIALS AND METHODS: The authors retrospectively studied 50 MR examinations of patients aged 2 months to 21 years, dividing them into six developmental groups according to the appearance of the distal tibia and fibula. Epiphyseal ossification, physeal closure, and the signal characteristics of physeal cartilage were evaluated. RESULTS: Distal tibial epiphyseal ossification and physeal closure both began anteromedially and usually occurred earlier than in the fibula. The tibial physis developed an anteromedial undulation (Kump hump) before closure; volume averaging at the Kump hump simulated premature closure. The cartilaginous epiphysis had a lower signal intensity than the physis on T2-weighted images. The physis was most conspicuous on gradient-recalled-echo and fat-suppressed spin-echo proton-density-weighted images. CONCLUSION: Developmental cartilaginous and bone changes in the distal tibia and fibula follow a definite pattern and are well seen at MR imaging.

Adolescent↗
PubMedDate not supplied

Impingement exostoses of the talus and fibula secondary to an inversion sprain. A case report.

Impingement exostoses of the talus and fibula following an inversion sprain is an uncommon sequela to the initial injury. Although a high frequency of symptomatic tibial and talar impingement exostoses have been reported, changes on the lateral side of the ankle are more subtle with significant roentgenographic findings rarely seen. The authors present a rare case of impingement exostoses involving both the talus and fibula simultaneously. Arthroscopy visualized the tibiotalar and talomalleolar articulations. It revealed opposing exostoses of the talus and fibula, necessitating surgical resection. Arthroscopy is recommended for difficult diagnostic problems of the ankle and an awareness of the condition of post-traumatic impingement exostoses of the talus and fibula.

Ankle Injuries↗
PubMed2002

[The value of preoperative routine donor leg angiography in free fibula flaps].

OBJECTIVE: To analyze the value of preoperative routine donor leg angiography in free fibula flaps. METHODS: Eighty-nine consecutive potential candidates for free fibula reconstruction were reviewed. They were further divided into two groups, group one received preoperative routine donor leg angiography, group two received only preoperative evaluation of dorsalis pedis and tibial posterior artery and without angiography. RESULTS: There were 49 patients in group one and 40 patients in group two. In group one, the results of preoperative angiography resulted in a change of the surgical plan in two patients. In group two, all the patients showed normal dorsilis pedis and tibial posterior artery, and fibula flap was harvested without preoperative angiography. One patient in each group showed venous deformity during the operation, and flap harvesting was abandoned. CONCLUSIONS: Routine preoperative angiography in free fibula flap is unnecessary. The following three conditions that require an angiography are: abnormal pedal pulses, significant previous lower leg trauma, and suspected vascular diseases.

Adolescent↗
PubMed1992

[Vascularized fibula transfer. A review].

The first vascularized fibula transfer was done by Ueba et al. (1983) in 1974 and has since become a standard technique for special indications in the English, French, Japanese and Chinese-world. Within the last 5 years this technique has received more and more attention in the German-speaking countries. The vascularized fibula transfer is successfully used to reconstruct segmental bone defects larger than 5 to 8 cm that are caused by trauma, tumor, pseudarthrosis or congenital defects. When used to treat osteomyelitis, the vascularized fibula transfer failed to fulfill expectations. Bone defects smaller than 10 cm can also be treated by vascularized iliac crest transfer. To achieve rapid healing, the following points must be followed carefully: when treating osteomyelitis, the infection must be healed--negative cultures and good granulation tissue--prior to bone transplantation. Application of systemic or local antibiotics and aggressive debridement of necrotic bone and soft tissue must be carried out until the cultures taken from the wound are negative. Soft tissue defects must be treated by soft tissue transfer in order to facilitate wound closure with well-vascularized tissue. Vascularized bone transfer should be the treatment of choice for the femur and upper extremities. Precise preoperative planning, especially in high-energy trauma cases, reduces the complication rate. Rigid internal fixation of the bone graft with the recipient site by a smaller proximal and distal plate or by a plate bridging the whole bone defect running parallel to the fibula graft leads to rapid healing without malalignment.(ABSTRACT TRUNCATED AT 250 WORDS)

Bone Neoplasms↗
PubMedDate not supplied

Immediate loading of dental implants placed in revascularized fibula free flaps: a clinical report on 2 consecutive patients.

PURPOSE: The objective of this study was to report the clinical outcome of dental implants placed in revascularized fibula flaps for the reconstruction of severely atrophied edentulous maxillae and immediately loaded with full-arch implant-supported prostheses. MATERIALS AND METHODS: Two patients, a 55-year-old woman and a 59-year-old woman, who presented with severely atrophied edentulous maxillae and local anatomy incompatible with rehabilitation with conventional complete removable dentures and insufficient bone volume for placement of implants of adequate dimensions were selected for reconstruction with revascularized fibula free flaps. Three months after the reconstructive procedure, Brånemark System dental implants (8 in the 55-year-old patient, 7 in the 59-year-old patient) were placed in the reconstructed areas and immediately loaded with implant-supported full-arch prostheses. The mean follow-up period of implants after the start of prosthetic loading was 24 months. Radiographic peri-implant bone level changes and peri-implant clinical parameters (Plaque Index, Bleeding Index, and probing depth) were evaluated. RESULTS: No implants were lost during the follow-up period. Implant survival and success rates were 100% and 93.3%, respectively. Peri-implant clinical parameters presented values consistent with those obtained for implants placed in native nonreconstructed bone and allowed to heal before loading. DISCUSSION: To the authors' knowledge, this is the first time that the successful immediate loading of implants placed in fibula free flaps for the rehabilitation of totally edentulous patients with severely resorbed maxillae or mandibles has been described. CONCLUSION: Despite the limited number of patients and the short follow-up period, immediate loading of implants placed in revascularized fibula free flaps appears to be a reliable method for the dental rehabilitation of these patients.

Alveolar Ridge Augmentation↗
PubMed2006

[Application of CTA and CAD\CAM techniques in mandible reconstruction with free fibula flap].

OBJECTIVE: To explore the application of computed tomographic angiography (CTA) and computer aided design\manufacture (CAD\CAM) techniques in mandible reconstruction with free fibula flap. METHODS: 7 cases of complex mandible defect were reconstructed with free fibula flap. Patients' lower extremity vasculature was evaluated by preoperative CTA examination; mandible tumor resection and reconstruction were simulated by CAD technique, the surgical template was manufactured with CAM technique preoperatively; and fibula flap was shaped according to surgical template during mandible reconstruction operation. RESULTS: Preoperative CTA examination performed without complication, the desired anatomy was adequately demonstrated in all patients. All of flaps survived, patients' facial contour are symmetry approximately. CONCLUSIONS: CTA and CAD\CAM techniques have important value for complex mandible reconstruction in selection of donor site, planning of operation and shaping of fibula flap.

Adolescent↗
PubMed1991

Plating of the fibula. Its potential value as an adjunct to external fixation of the tibia.

There is added stability when plate fixation of the fibula supplements the external fixator used in treating tibial fractures associated with a segmental defect. An anatomic specimen model of a Grade III open fracture of the tibia with an associated fibular fracture was used in this study. Fibular internal fixation using an AO standard plate was performed on one of each of five matched pairs of legs. These were then subjected to identical loads in compression and torsion. The numeric values obtained during loading in all modes were converted to ratios between each of the tested pair to directly compare the effect of stabilization of the fibula. The final results showed that in each case, the preparation with fibular plating had improved resistance to deformation in axial loading. On average, the plated specimens were 2.2 times stiffer. In torsion, plating the fibula did not appear to affect the resistance of the construct to the applied load. Supplemental plate fixation of the fibula in fractures of the tibia with segmental defects may improve subsequent morbidity. The increased rigidity of the system may be sufficient to allow partial to full weight bearing immediately after surgery. This may have significant value in the management of the polytraumatized patient.

Biomechanical Phenomena↗
PubMed1991

Failure of centralization of the fibula for congenital longitudinal deficiency of the tibia.

Between 1962 and 1983, fourteen patients (twenty knees) had centralization of the fibula for congenital longitudinal deficiency: tibial, complete. Eleven of the twenty index procedures were performed on patients who were one year old or less. A progressive flexion deformity of the knee developed after all twenty index procedures. Twenty-six secondary procedures were needed, including disarticulation at the knee, posterior release, extension osteotomy, femorofibular arthrodesis, and biceps-to-quadriceps transfer, and one patient had a second attempt at centralization of the fibula. The duration of follow-up after the initial centralization of the fibula ranged from four years to twenty-two years and seven months (average, twelve years and four months). Seven patients (eight limbs) in whom the index procedure resulted in failure had a satisfactory result after disarticulation at the knee. The patients who did not have secondary disarticulation at the knee are also considered to have had a failed index procedure because they had a flexion deformity at the latest follow-up. Attempts to reconstruct the knee joint by centralization of the fibula are not warranted for patients who have congenital longitudinal deficiency: tibial, complete. Early disarticulation at the knee and fitting with a prosthesis, with close follow-up, is the treatment of choice.

Amputation, Surgical↗
PubMed1984

Longitudinal growth rate of the distal tibia and fibula in children.

In 61 children (30 boys and 31 girls), the growth rates in the distal tibia and fibula were recorded by use of a roentgen stereophotogrammetric technique. The average observation time was about one year and seven months. The growth rates were correlated with chronologic and skeletal age. Adjusting for skeletal age did not significantly change the average growth rates or the scattering of the values. The mean growth rate and the remaining growth from about nine years of age in the boys and eight years of age in the girls were calculated for separate age groups. In the distal tibia in the boys and the girls, the average growth rate decreases from a plateau of about 11 and ten years of age, respectively. Decreasing growth rates were found somewhat later in the distal tibia than in the distal fibula in both the boys and the girls. The growth rates were close to zero at about the same time in the distal tibia and fibula in both sexes. In determining the remaining growth, the large biologic variability indicates the importance of serial measurements on the individual patient. The individual growth charts, together with clinical and radiographic estimation of maturity, provide a guideline for treatment of a patient with growth disturbance of the distal tibia and fibula.

Adolescent↗
PubMed1980

Problems associated with tibial fractures with intact fibulae.

Of twenty-three patients more than twenty years old who were treated for a tibial shaft fracture without a concomitant fibular fracture, six (26 per cent) had delayed union or non-union and six (26 per cent) had varus malunion of the fractured tibia. Pain and roentgenographic changes developed in the ipsilateral ankle within two years of injury in two of these six patients with malunion. Of forty-five patients less than twenty years old with similar fractures, one had delayed union and twelve (27 per cent) had varus malunion. Pain in the ipsilateral ankle was observed in two of these twelve patients with malunion. In addition, a bent fibula was observed in thirteen patients who incurred their fractures when they were less than twenty but in no patients who were more than twenty years old at the time of fracture. Clinical observations were corroborated by biomechanical studies on an experimental model. These studies suggested that when the fibula remains intact, a tibiofibular length discrepancy develops and causes altered strain patterns in the tibia and fibula. These may lead to delayed union, non-union, or malunion of the tibia with the sequelae of joint disturbances. The lower incidence of complications in patients less than twenty years old may be due to the greater compliance of their fibulae and soft tissues.

Adolescent↗
PubMed1994

Fibula osteoseptocutaneous flap for reconstruction of composite mandibular defects.

The fibula osteoseptocutaneous flap is a versatile method for reconstruction of composite-tissue defects of the mandible. The vascularized fibula can be osteotomized to permit contouring of any mandibular defect. The skin flap is reliable and can be used to resurface intraoral, extraoral, or both intraoral and extraoral defects. Twenty-seven fibula osteoseptocutaneous flaps were used for composite mandibular reconstructions in 25 patients. All the defects were reconstructed primarily following resection of oral cancers (23), excision of radiation-induced osteonecrotic lesions (2), excision of a chronic osteomyelitic lesion (1), or postinfective mandibular hypoplasia (1). The mandibular defects were between 6 and 14 cm in length. The number of fibular osteotomy sites ranged from one to three. All patients had associated soft-tissue losses. Six of the reconstructions had only oral lining defects, and 1 had only an external facial defect, while 18 had both lining and skin defects. Five patients used the skin portion of the fibula osteoseptocutaneous flaps for both oral lining and external facial reconstruction, while 13 patients required a second simultaneous free skin or musculocutaneous flap because of the size of the defects. Four of these flaps used the distal runoff of the peroneal pedicles as the recipient vessels. There was one total flap failure (96.3 percent success). There were no instances of isolated partial or complete skin necrosis. All osteotomy sites healed primarily. The contour of the mandibles was good to excellent.

Adult↗
PubMed1996

[Free-flap fibula for the reconstruction of composite mandibular defects].

The advent of microsurgery has revolutionized the reconstruction of composite tissue defects of the mandibular region. Well-vascularized bone and soft-tissues can be used to repair any kind of oromandibular defects and many of the morphological and functional goals of mandibular reconstruction can now be achieved. The ideal flap should provide a vascularized bone of sufficient length and height, easily shaped to match the original mandible with a thin, abundant soft-tissue component. The donor site morbidity should be minimal and a two-team approach possible. Different flaps have been used for mandibular reconstruction including fibula, iliac crest, radius and scapula. According to us, fibula free-flap satisfies many of these requirements and is the flap of choice in most cases of difficult mandibular reconstruction. 8 fibula free flaps were used in 6 cases of primary and 2 cases of secondary reconstructions. The defects were secondary to resections of oral cancers in 4 cases and of osteosarcomas in 4 cases. The mandibular defects were between 8 and 16 cm in length. Multiple osteotomies were used to shape the bone and miniplates were utilized for rigid fixation of the osteotomized bone and of the remaining mandible. An important soft-tissue defect was present in 6 cases requiring a skin paddle for oral lining. In 6 cases there was a complete survive of the flaps with very satisfactory results and good mandibular contour. There was one flap failure for a venous thrombosis and in one case the flap was removed after 8 days for complications independent of the microvascular technique. Donor site morbidity was minimal with no significant gait disturbance. In conclusion, the advantages of microvascular surgery and the reliability of fibula free-flap make it an attractive and versatile option in one-stage reconstruction of composite tissue defects in the mandibular region.

Adult↗
PubMed1997

Growth and growth prediction of the fibula.

Growth prediction data and graphs have not been available previously for the fibula. In this report, this information is wholly derived from a longitudinal radiographic study of growth in children. Teleradiographs of the tibia and fibula in 244 children (123 boys and 121 girls) were made at 6-month intervals from age 7 until skeletal maturity. Length measurements determined the growth of the fibula. The subjects were healthy well nourished middle class Americans, mostly of Northwest European descent. Growth occurring at the fibular growth plates was determined by the relationship to the tibia. The contribution of the proximal and distal growth plates to total length was determined by multiplying the percentage of growth occurring at each age by the longitudinal growth remaining. Graphs then were constructed using the logarithmic adjustment of Colin Moseley to produce a straight line graph. The proportion of growth occurring at the proximal and distal growth plates is not equal. More growth occurs at the proximal growth plate of the fibula than at the proximal growth plate of the tibia. The overall growth contribution of the proximal fibular growth plate is 61% compared with 57% for the proximal tibia. The graphs provided allow accurate prediction of fibular growth.

Adolescent↗
PubMedDate not supplied

Isolated fractures of the tibia with intact fibula in children: a review of 95 patients.

Isolated tibial fractures with an intact fibula are the most common tibial fracture pattern in children. When displaced, this fracture can be difficult to reduce and retain in the position because of the splinting of the intact fibula. A 4-year review of 95 children with fracture of the tibia with an intact fibula was performed at the Children's Hospital of Eastern Ontario. Eighty-one percent of the fractures were caused by an indirect rotational twisting force. Seventy-three percent of fractures were localized at the distal third of the tibial shaft. Varus angulation deformity occurred most commonly when the fracture line started distally on the anteromedial side of the tibia and progressed in an oblique or spiral manner to the proximal posterolateral aspect of the tibia. This was postulated to be caused by the posterior flexor muscle forces being more concentrated medially, whereas laterally, the intact fibula acts like a splint, thus producing a bending moment resulting in varus angulation. Close follow-up and monitoring of the isolated tibial fractures with weekly radiographs for the first 3 weeks is recommended.

Accidents↗
PubMed1998

Treatment of a chronic comminuted fracture of the fibula in a horse.

A four-year-old Standardbred gelding was examined because of vague right hind limb lameness of 3 to 4 months' duration. Results of physical examination, radiography, and scintigraphy were indicative of a chronic comminuted fracture of the proximal portion of the right fibula. A cancellous bone graft was placed in the fracture site, and 3 months later, the fracture appeared to be healed radiographically. Fractures of the fibula are rare in horses and should not be confused with normal anatomic discontinuities that result in a bi- or tripartite appearance of the fibula on radiographs. Because the fibula is a non-weight-bearing bone in horses, lameness associated with fibular fractures may be vague.

Animals↗
PubMed1997

[Repair of long segment bone defect of femur by free juxtaposed bilateral fibulae autograft].

There were several methods, such as free single and folded fibulae autograft, composed tissue autograft, however, it is still very difficult to repair long segment bone defect. In December 1995, we used free juxtaposed bilateral fibulae autograft to repair an 8 cm of femoral bone defect in a 4 years old child in success. The key procedure is to strip a portion of the neighboring periosteal sleeve of juxtaposed fibulae to make bare of the opposite sides of the bone shafts, suture the opposite periosteal sleeves, keep the nutrient arteries, and reconstruct the blood circulation of both fibular by anastomosis of the distal ends of one fibular artery and vein to the proximal ends of the other fibular artery and vein, and anastomosis of the proximal ends of the fibular artery and vein to lateral circumflex artery and vein. After 22 months follow up, the two shafts of juxtaposed fibulae fused into one new bone shaft. The diameter of the new bone shaft was nearly the same as the diameter of the femur. There was only one medullary cavity, and it connected to the medullary cavity of femur. This method also cold be used to repair other long segment bone defect.

Anastomosis, Surgical↗
PubMed2006

Phalloplasty with free (septocutaneous) fibular flap sine fibula.

PURPOSE: The free prefabricated fibular flap has been used as a good alternative to the free radial forearm flap in female-to-male sex reassignment surgery. We describe a new technique of harvesting the flap without sacrificing the fibula. The neophallus is thinner, more elegant, less rigid and able to contain a hydraulic penile prosthesis. MATERIALS AND METHODS: Five biologically female patients underwent reassignment surgery using this technique. Average patient age was 30 years (range 24 to 37) and average followup was 25 months. All patients underwent total hysterectomy, salpingo-oophorectomies, vaginectomy and urethral prelamination 6 months before flap surgery. The lateral calf cutaneous island was raised on the peroneal artery septocutaneous perforators without disrupting the continuity of the fibula. Urethro-urethral anastomosis was done 3 months later. RESULTS: All patients sustained good results with no flap loss. Voiding from a standing position was achieved and the neophallus was esthetically acceptable. Donor morbidity was minimal with no disturbance to ambulation compared to the conventional method, in which the fibula is sacrificed. CONCLUSIONS: The free fibular flap without the fibula is a challenging refinement of neophallus construction that confers benefits to recipient and donor sites. It is a welcomed addition to the armamentarium for neophalloplasty.

Adult↗
PubMed2004

[Free microvascular fibula graft for skeletal reconstruction after tumor resections in the forearm -- experience with five cases].

Plastic-reconstructive surgery for upper extremity tumors not only follows the fundamental principles of oncologic surgery, but also requires attention to functional and aesthetic aspects. For soft tissue reconstruction, a variety of surgical options are available, whereas for the reconstruction of extensive bony defects only the free microvascular fibular transplant appears to be a reasonable method. Its advantages are its slim shape and variable length, the possibility of achieving a stable osteosynthesis suitable for early physiotherapy, and low donor site morbidity, even if the fibula is harvested as an osteoseptocutaneous flap. Between 1994 and 2000, five patients underwent a free fibula transplantation for radius reconstruction. In all cases, a two-stage reconstructive approach with initial tumor biopsy was chosen. The resected tumors were two osteosarcomas, one extraosseous Ewing sarcoma, one aneurysmatic bone cyst and one desmoplastic fibroma. Surgical and pathohistological tumor-free margins were achieved in all cases (R(0)). Two patients received an osteocutaneous graft. All grafts were revascularized to the radial artery and subcutaneous veins. The transplanted fibula grafts were between 10 cm and 17 cm in length. All proximal osteosyntheses were performed fibuloradially, the distal stabilizations were fibulo-scapho-lunate (2 x) and fibulo-radial (3 x), depending on the extent of resection. All microvascular transplants survived completely and showed a stable osseous integration, both clinically and radiologically. Depending on the postoperative course, an adapted intensive physiotherapy regimen yielded good or satisfactory function. In the follow-up of up to seven years in one case a tumor recurrence (osteosarcoma, 35 months post-operatively) required forearm amputation. The reconstruction of tumor-associated wide bony defects in the upper extremity with a free microvascular fibula graft allows for a successful therapy with respect to oncologic, functional and aesthetic considerations.

Adolescent↗