Fibular non-union in distraction osteogenesis of the tibia

Abstract

IntroductionThere is concern regarding potential non-union of the fibula following distraction osteogenesis and if non-union of the fibula leads to poor outcome. HypothesisAssess the incidence of fibula non-union in patients undergoing distraction osteogenesis of the tibia and to report the effects on patient outcome. We also describe the management of this complication. Materials and methodsA consecutive series of patients undergoing distraction osteogenesis at a tertiary centre under a single surgeon. The amount of distraction, site of osteotomy, union of the fibula and tibia were recorded. ResultsFifty-eight distraction procedures. Mean age was 37.2, 36 males and 22 females. Mean follow-up 23.4 months. 49 (84.5%) achieved fibula union at frame removal, and 9 (15.5%) went on to non-union. Of the fibulas that united, the mean lengthening was 9.25mm. In fibula non-union there was significantly greater lengthening (23.66mm) (p=0.004). Fifty-four (93.1%) of the tibias united following osteotomy and distraction, whilst 4 (6.9%) went onto non-union requiring operative treatment. Of the 4 tibias that did not unite, 3 (75%) also had fibula non-union (p=0.01). Three (33.3%) of the 9 fibulas that did not unite developed symptoms. Two of these required surgery in the form of fibula plating. Both of these patient's symptoms resolved following surgery. DiscussionFibula non-union is a relatively common complication following osteotomy in distraction osteogenesis. The length of fibula distraction and tibia non-union are significant risk factors. We recommend surgical intervention for those patients who have symptomatic fibula non-unions. Level of evidenceIV, case series.