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At least 19 recordsLinked to original sources
PubMed2000

Traumatic medial malleolar fracture of a fibula flap donor leg.

A 50-year-old male presented with a T4 N0 squamous cell carcinoma of the floor of the mouth and alveolus. Treatment included a partial mandibulectomy with a free osseocutaneous fibula flap reconstruction. He made a good postoperative recovery and was given adjuvant radiotherapy. No problems were reported with the donor site or ankle. Five months after harvesting the flap the patient sustained a fracture of the medial malleolus having jumped over a ditch playing golf. This was treated successfully with a below knee plaster of Paris cast. The interosseous membrane was not ruptured in the accident indicating that the distal fibula left in situ was adequate to maintain the integrity of the mortice. A degree of ankle instability may be present after fibula flap harvest which is only revealed by athletic activity. (c) 2000 Harcourt Publishers Ltd Copyright 2000 The British Association of Plastic Surgeons DOI: 10.1054/bjps.1999.3227.

Journal Article↗
PubMed1998

The role of fixation of the fibula in open fractures of the tibial shaft with fractures of the ipsilateral fibula: indications and outcomes.

To determine the indications for fibular fixation in cases of combined fractures of the tibia and fibula and the effect of fibular fixation on tibial healing, a retrospective study of open fractures of the tibial shaft with concomitant fibula fractures was conducted at a level one trauma center. Apparent indications for fibular fixation included the presence of a syndesmotic injury and location of fracture within the distal third of the fibula. No significant differences were found in the healing rates, incidence of nonunion and malalignment, or in the number of required subsequent procedures between patients who did and did not undergo fibular stabilization. These results suggest that fixation of the fibula in open fractures of the tibia and fibula has no effect on fracture healing or alignment. A randomized, prospective study is needed to properly validate these findings.

Fibula↗
PubMedDate not supplied

Internal fixation of distal fibula fractures: a case presentation demonstrating a unique technique for a severely comminuted fibula.

The laterally comminuted fracture-dislocation of the ankle can be associated with devastating consequences. Previously described surgical as well as nonsurgical-treatment results have been disappointing. Accurate anatomical reduction and rigid fracture stabilization of a comminuted fibula can be extremely difficult. This manuscript presents some of the more common methods of comminuted fibular fracture fixation described in the literature. A case report demonstrates successful anatomical stabilization of a comminuted fibula, utilizing a method for internal fibular fixation which has been previously employed, but has not been advocated, in the literature. Clinical and radiographic results at 12 and 20 months post-injury are promising.

Adult↗
PubMed1991

Fusion rates in multilevel cervical spondylosis comparing allograft fibula with autograft fibula in 126 patients.

Surgical fusion results are presented from a retrospective study of 126 consecutive multilevel discectomy and vertebrectomy cases for spondylosis to evaluate fusion rates using autograft and allograft fibula strut graft for reconstruction. The nonunion rate was high in both groups: 27% of the autograft group and 41% of the allograft group. The nonunion rate increased with increasing numbers of motion segments fused. Age and sex were not significant factors.

Adult↗
PubMed2000

The vascularized pig fibula bone flap model: effect of segmental osteotomies and internal fixation on blood flow.

The free fibular flap is the flap of choice for reconstruction of complex mandibular defects, although two or more osteotomies may be required to recreate the normal mandibular contour. The effect of these surgical manipulations on the fibula has not been adequately investigated. This study was designed to study the effect of multiple segmental osteotomies and internal fixation techniques on blood flow in the vascularized pig fibula bone flap model. The hindlimbs of 15 Yorkshire pigs were randomized into 1 of 5 groups (n = 6 fibulae per group) consisting of: (1) a nonoperated, in situ fibula; (2) an elevated fibula flap; (3) an elevated fibula flap with two segmental osteotomies; (4) an elevated fibula with two segmental closing osteotomies rigidly fixed with 2-mm miniplates; (5) an elevated fibula with two segmental closing osteotomies rigidly fixed with 2-mm lag screws. Total and gradient blood flow was measured in the bone and soft-tissue components of these flaps using the 15-microm radioactive microsphere technique. The creation of two segmental osteotomies in the vascularized pig fibula bone flap model resulted in a significant decrease (p<0.05) in the gradient blood flow in the segment of bone distal to the second osteotomy. Application of miniplates or lag screws across closing osteotomies resulted in a significant decrease (p<0.05) in total and gradient blood flow to the bone component of the fibulae, as compared with the elevated and osteotomized fibulae groups. An increase in blood flow suggesting a hyperemic response was noted in the bone and soft tissue in the elevated and osteotomized flap groups as compared with the in situ, nonoperated controls. This study established the validity of the pig fibula as a suitable model for investigating the pathophysiology of blood flow changes in the face of standard surgical maneuvers necessary for the restoration of mandibular form and function. The results demonstrated that the creation of multiple segmental osteotomies and the application of internal fixation significantly decreases (p<0.05) blood flow to the distal portion of the flap. The effects of segmental osteotomies and internal fixation on healing and growth of the pig fibula bone flap model are investigated in a separate study.

Animals↗
PubMed1997

The role of fibular fixation in combined fractures of the tibia and fibula: a biomechanical investigation.

OBJECTIVES: To determine whether adjunctive plating of the fibula with tibial fixation enhanced the stability of the construct under combined compressive and bending loads in simulated fractures of both the tibia and fibula. METHODS: Each of twelve fresh cadaveric specimens (six pairs) with an intact knee, lower extremity, and foot was mounted on the table of a materials testing machine. An intramedullary (IM) rod locked in the distal femur allowed combined compression, and flexion, valgus bending, or varus bending loads to be transmitted from the actuator of the testing machine to the knee. Three displacement measurement transducers were mounted on the tibia at anterior, posterolateral, and posteromedial positions. Intact tibial deformations under load were measured. Then, in one specimen of each pair a 2 cm osteotomy was created near the tibial midshaft, which was stabilized with an external fixator. Tibial gap displacements were measured under the following conditions: (a) intact fibula, (b) osteotomized fibula, (c) fibula fixed with a plate, (d) fibula fixed with an Enders IM nail. In the other specimen of the pair, tibial fixation was performed with an interlocked unreamed IM nail, with the same successive stages of fibular fixation. RESULTS: Osteotomy of the fibula significantly increased tibial defect motion when external fixation was used, and plating the fibula in this case significantly decreased motion. Using an Enders rod to stabilize the fibula instead of a plate, with tibial external fixation, produced smaller decreases in tibial defect site motion. With IM rod fixation of the tibia, osteotomizing the fibula had no effect on defect site motion or on its subsequent stabilization using a plate or IM rod. CONCLUSION: Plating the fibula can decrease motion across a tibial defect, but only when less rigid (i.e., external) fixation is used.

Biomechanical Phenomena↗
PubMed1998

The current role of preoperative arteriography in free fibula flaps.

The free fibula flap has become a "workhorse" flap for reconstructive surgeons, yet the indications for preoperative arteriography for the donor extremity remain unclear. Therefore, a retrospective review of all free fibula candidates over a 4-year period was conducted to clarify the need for preoperative arteriography. One hundred consecutive patients were evaluated as potential candidates for free fibula reconstruction. Twenty-one patients were deemed unsuitable because of associated comorbid conditions (15) or unusable limbs (6). The remaining 79 patients were candidates for fibula free flap reconstruction. Eight patients (10 percent) who had an abnormal lower extremity vascular physical examination (diminished or absent pedal pulses) underwent arteriography to evaluate the fibula donor site. Free fibula transfer was performed in 77 patients (mean age, 41; range, 3 to 80 years) to the following sites: mandible (65), upper limb (4), lower limb (6), and trunk (2). The overall free flap success rate was 99 percent. Results of arteriography included: normal three-vessel runoff (6), bilateral peroneal arteria magna (1), and bilateral posterior tibial artery occlusion with reconstitution via the peroneal artery (1). Two patients with unusable fibula donor sites (determination based on arteriographic findings) were reconstructed with ilium and radius. All others underwent uncomplicated free fibula transfer. Ischemic complications at the fibula donor site did not occur in any patient. This study supports the use of lower extremity vascular physical examination as the primary means of evaluating the fibula donor site. Routine preoperative arteriography is unnecessary and should be reserved for those patients with abnormal vascular examinations.

Adolescent↗
PubMed1999

The vascularized pig fibula bone flap model: effects of multiple segmental osteotomies on growth and viability.

Previous work by this laboratory introduced the pig fibula bone flap as a model for the study of the pathophysiology of vascularized bone flaps. Anatomic and hemodynamic studies demonstrated a significant (p < 0.05) decrease in vascular perfusion after a series of segmental osteotomies and rigid fixation (lag screws and miniplates) in the distal end of the flap, suggesting that blood flow to the distal osteotomized segment of the flap may be impaired. Killing the animals after blood flow studies precluded assessment of the effect of these hemodynamic changes on bone healing. Therefore, the aim of this study was to assess the pig fibula bone flap model with respect to viability, healing, and subsequent growth after multiple segmental osteotomies and rigid fixation to contribute to the understanding of vascularized bone flap pathophysiology. Yorkshire pigs (20 to 25 kg) were used for all experiments. Eight pigs underwent unilateral elevation of a vascularized fibula bone flap, which was osteotomized into three segments and orthotopically rigidly fixed using a 2.4-mm mandibular reconstruction plate. The left fibula remained as the control. Fluorochrome labels were injected to assess bone viability and turnover, and both fibulae were assessed for growth radiologically. The fibulae were harvested 21 days postoperatively (when the animals were killed), and bone healing was assessed histologically and clinically. There were no significant differences in preoperative and postoperative lengths of the osteotomized fibulae compared with the controls, suggesting that there was no impairment of growth potential after multiple segmental osteotomies and rigid fixation. Significant (p < 0.05) bony hypertrophy of the osteotomized fibulae was noted when compared with controls. Mobility was observed in 3 of the 32 osteotomies (9 percent), occurring across one proximal and two distal osteotomies in association with failure of fixation. However, histologic and fluorochrome assessment confirmed the viability of all bone segments, as supported by the presence of tetracycline given 2 days postoperatively. The pig fibula bone flap model is well tolerated by the pig. Multiple segmental osteotomies and rigid fixation, previously associated with a significant decrease in blood flow in the distal segment, did not impair either growth potential, viability, or healing ability. It is suggested that the pig fibula is a suitable model for the study of bone flap pathophysiology.

Animals↗
PubMed2003

Fibula free flaps: the role of angiography in patients with abnormal results on preoperative color flow Doppler studies.

BACKGROUND: The reliability of normal color flow Doppler (CFD) study results in predicting the safety of fibula free flap harvest has been recognized. The significance of abnormal CFD study results when used for preoperative assessment of a potential fibula free flap donor site is less well defined. OBJECTIVE: To determine if abnormal preoperative CFD study results should exclude fibula free flap harvest or if patients, in whom the fibula free flap is thought to be the best reconstructive option, should undergo further evaluation with angiography to better determine fibula free flap candidacy. METHODS: A retrospective review identified 17 potential fibula free flap candidates (34 legs) evaluated by both a lower extremity CFD study and a lower extremity angiogram. The results of the CFD study were then compared with those of angiography. RESULTS: There were 16 legs with normal CFD study results and subsequent angiographic findings confirming the safety of each of these legs for fibula free flap harvest. There were 18 legs that demonstrated abnormal CFD study results. Angiography revealed anatomy that was considered to represent a high risk for fibula free flap harvest in 16 legs and considered safe in the other 2 legs. All 14 legs that had at least 1 vessel with a monophasic waveform or no flow on the CFD study revealed a high-risk angiogram result. Of the 4 legs with biphasic waveforms in all trifurcation vessels on the CFD study, 2 revealed angiogram results that showed that they were safe for flap harvest. CONCLUSIONS: Preoperative CFD studies that reveal a monophasic waveform or absence of flow accurately identify unsafe donor sites. Fibula free flap harvest in these cases can be excluded based on abnormal CFD study results alone, eliminating the need to perform angiography.

Carcinoma, Squamous Cell↗
PubMed1993

Effect of upper tibial osteotomy on fibula movement and ankle joint motion.

Several techniques of upper tibial osteotomy in the treatment of unicompartmental osteoarthritis of the knee have been described. Osteotomy of the fibula is normally also carried out, or alternatively, dissection of the capsule of the proximal tibiofibular joint. There is concern, however, that this latter procedure may have an adverse effect on the mobility of the ankle joint and on fibula rotation. To investigate these suspected interactions we performed experimental studies in 14 cadaver legs. The vertical, lateral and rotational movements of the fibula were measured with the ankle in neutral (0 degrees) and maximal ankle dorsiflexion before and after performing an interligamental upper tibial osteotomy of a standardised valgus wedge. Maximal ankle dorsiflexion before the osteotomy produced external rotation of the fibula in most specimens, whereas after osteotomy this movement caused mainly internal rotation. In the neutral position of the ankle, upper tibial osteotomy lead to external rotation of the fibula. The upward movement of the fibula head after osteotomy was 0.64 cm on average. There was no measurable vertical motion of the fibula during ankle dorsiflexion either before nor after upper tibial osteotomy. Ankle dorsiflexion improved minimally after osteotomy. In conclusion, this study shows that upper tibial osteotomy with dissection of the capsule of the proximal tibiofibular joint has no adverse effect on movement of the fibula or of the ankle joint. In addition, unlike fibular osteotomy, this technique also has the advantage that the risk of common peroneal nerve injury is minimal.

Ankle Joint↗
PubMed2001

Topographical anatomy of the fibula and peroneal artery in Koreans.

Vascularized fibula flaps have many advantages in the restoration of the contour and function of the mandible. Potential disadvantages include, unreliable skin paddle and the limited volume of the fibula. This study was designed, to clarify the anatomy of the peroneal artery to the fibula and lateral leg skin, and to measure the dimensions of the fibula available for dental implant placement in Korean. Through the dissection of 63 legs of Korean cadavers, we demonstrated that in most cases the musculoperiosteal (mp) and septocutaneous (sc) branches of the peroneal artery were distributed at the middle and lower thirds of the fibula. There were double the number of mp perforators to the skin compared to sc branches. This indicates the inclusion of a generous > 1 cm cuff of Peroneous longus and flexor hallucis longus (FHL) in the distal and middle third of the fibula. The location of the nutrient foramen was just proximal to the midpoint. Thus, a 15-20 cm length of the fibula is available in Koreans and an 8 12 mm length of implant can be placed to the fibula, which provides sufficient bone to reconstruct a large mandibular defect.

Adolescent↗
PubMed1994

The need for preoperative leg angiography in fibula free flaps.

Among arterial anatomic conditions which will adversely affect the harvest of the fibula are 1) significant arteriosclerotic disease within the tibial-peroneal vessels; 2) peroneal arteria magna (PAM), a condition in which only the peroneal artery supplies the foot; and 3) absence of the peroneal artery, either congenitally or as an acquired defect. In each of these anatomic conditions, removal of the peroneal vessels and the fibula free flap will jeopardize either the donor leg, the fibula flap, or both. All patients considered for fibula flaps were evaluated with preoperative leg angiograms. In 28 consecutive patients evaluated with angiography for planned free-fibula flap reconstructions, 23 actually underwent free-fibula harvest. Angiographic abnormalities that altered the operative plan were found in seven (25 percent) patients. Four of the seven patients had vascular examinations prior to surgery with abnormal findings. Three of the seven (11 percent) patients with abnormal arterial anatomy had normal vascular examinations prior to surgery. Thus, if a preoperative angiogram had not routinely been done, the abnormal anatomy would not have been discovered until surgery. This could have resulted in an unusable flap in one patient, and an ischemic or gangrenous foot in two other patients. With this angiographic guidance, there were no vascular complications from harvest of the fibula. The routine use of preoperative bilateral leg angiography is recommended, or an alternative method of vessel imaging, in all patients evaluated for microvascular free-tissue transfer of the fibula.

Angiography↗
PubMed1999

Anterior cervical discectomy with freeze-dried fibula allograft. Overview of 317 cases and literature review.

STUDY DESIGN: A retrospective review of 317 patients to determine the efficacy of allogeneic fibula arthrodesis after anterior cervical discectomy. OBJECTIVE: To examine the efficacy of allogeneic fibula as an alternative fusion substrate after anterior cervical discectomy, and to determine the effects of cigarette smoking on the healing of fibula allografts. SUMMARY OF BACKGROUND DATA: The use of autogeneic iliac crest is associated with graft harvest complications in up to 20% of patients. Most studies reporting on the use of allogeneic iliac crest cite a high collapse rate. Few studies exist that note the efficacy of allogeneic fibula in this procedure and the effects of cigarette smoking on fusion rate. METHODS: From 1988 to 1993, 317 patients underwent grafting by the Smith-Robinson technique with allogeneic fibula after anterior cervical discectomy. Patients who described themselves as habitual cigarette smokers or who smoked during the perioperative or postoperative period were categorized as smokers. All patients were immobilized in a rigid cervical orthosis (Philadelphia collar) for at least 10 weeks postoperatively. RESULTS: A minimum of 2 years follow-up was achieved in 289 patients. In all, 162 men and 127 women had a total of 311 levels grafted, and the mean follow-up period was 33 months (range, 24 to 51 months). Of patients who received allogeneic fibula at one level, 90% (242/269) achieved radiologic fusion. The fusion rate was 92% (182/198) among nonsmokers compared with 85% (60/71) among smokers (not a statistically significant difference; P = 0.120). After two-level procedures, 72% (13/18) of the patients showed fusion. The fusion rate was 50% (2/4) among smokers compared with 79% (11/14) among nonsmokers (P = 0.53). When one-level arthrodesis (90%) was compared with two-level arthrodesis (72%), the difference approached statistical significance (P = 0.054). Neither of the two patients, both nonsmokers, who received grafts at three levels achieved fusion. There were no infections, and no grafts collapsed. Two grafts extruded (0.6%), but these were partial and did not require reoperation. Both patients fused and constituted the only patients with more than 10 degrees of angulation in the series. Graft subsidence occurred in 5% (17/311) of the grafts, mostly in the beginning of the series, and was not problematic. This phenomenon was thought to have been caused by overaggressive removal of the cortical endplate. CONCLUSION: Allogeneic fibula is an effective substrate for use in achieving fusion after anterior cervical discectomy. Maximal results are achieved with its use at one level in nonsmokers. Cigarette smoking decreased the fusion rate with allogeneic fibula in the anterior cervical spine, but not by a statistically significant amount.

Cervical Vertebrae↗
PubMed1996

Banked fibula and the locking anterior cervical plate in anterior cervical fusions following cervical discectomy.

Eighty-eight consecutive patients underwent anterior cervical discectomy (ACD) with banked fibula fusion and internal fixation using the locking cervical plate. Pathology included cervical spondylotic radiculopathy in 48, cervical spondylotic radiculomyelopathy in 30, cervical facet dislocations with associated disc herniations in six, and autologous iliac crest graft collapse pseudoarthrosis with recurrent symptoms in four patients. Operations were single-level banked fibula fusion with plating in 37, multilevel banked fibula fusion with plating in 45, and combined single-level ACD banked fibula fusion with plating and posterior fusion in six patients. The only perioperative complication was transient hoarseness. There were no transfusions, infections, neurological injuries, or deaths. The mean time in the hospital for the nontraumatic cases was 1.8 days. The mean follow up was 22 months (range 12-30 months). There has been no motion at the fused level on flexion/extension films, no kyphosis, no screw plate backout, and no banked fibula has suffered graft collapse. Following a high-speed motor vehicle accident 6 months after a multilevel fusion, one alcoholic man suffered a fractured plate with transient worsening of neck pain, and the plate has remained in place for an additional 11 months of follow-up care. Compared to 100 consecutive autologous iliac crest fusions performed by the same surgeon, there were significantly fewer graft-related complications (p < 0.001). There was a significantly greater chance of autologous iliac crest collapsing with the passage of time as compared to banked fibula. Time until return to work was shorter by 5 weeks for the plate/banked fibula group (p < 0.05). When fusion is considered following ACD, the combination of banked fibula and locking cervical plates is significantly superior to autologous iliac crest grafts.

Adult↗
PubMed2000

[Treatment of tibia and femur massive defect with pedicled fibula transposition].

OBJECTIVE: To investigate the repairing result for the massive bony defects of upper and middle tibia and lower femur. METHODS: Since 1974, four types of pedicled-fibula transposition were performed to repair the massive bone defect of tibia and femur in 25 cases, which included; 9 cases with benign tumor of upper part of tibia were performed muscle-pedicled fibula transposition and knee fusion after tumor resection; 9 cases with extensive benign tumor or tumoroid lesion of tibia shaft were performed muscle-pedicled fibula transposition and tibia-fibula fusion after tumor resection; 2 cases with extensive benign tumor or tumoroid lesion of middle and lower parts of tibia were performed vascular pedicled fibula transposition and tibia-fibula fusion; 5 cases with benign tumor of distal femur were performed vascular pedicled fibula reversal transposition and knee fusion. RESULTS: After 3 months to 11 years follow-up, 23 cases showed bone healing at 6 months postoperatively. The other 2 cases showed bone healing at 12 months postoperatively. All cases had satisfactory functional rehabilitation. CONCLUSION: Pedicled-fibula transposition is a choice method for repairing massive defects of tibia and femur.

Adolescent↗