Reconstruction of lateral malleolus with a free iliac bone graft

Abstract

Objective To explore reconstruction of lateral malleolus with a free iliac bone graft. Methods The clinical data of 5 patients with traumatic compound loss of lateral malleolus and skin were retrospectively analyzed who had been treated at our department from June 2010 to April 2012. They were 3 males and 2 females, 23 to 56 years of age (average, 35.4 years). The bone defect was on the left side in 2 cases, on the right side in 3 cases, and beyond the inferior syndesmosis in all. The bone defects ranged from 3.2 cm to 4.5 cm in length. In the staged treatment, the wounds were repaired by free skin flap transplantation in the first stage while the lateral malleolus defects were rebuilt with a free iliac bone graft in the second stage. Results The skin flaps survived primarily in all the 5 cases. All the cases were followed up for 33 to 38 months (average, 35.4 months). The bone healing time was from 5.5 to 8.0 months (average, 6.8 months). Arthritis occurred 11 months after surgery and limping gait was found 35 months after surgery in one case whose lateral articular surface of the talus was found partially stripped intraoperatively. No limping gait or pain was found in the other 4 cases who obtained a stable ankle with nearly a full range of motion. Their joint surface was matching, and their joint clearance was normal. No secondary fractures occurred. According to the American Orthopaedic Foot and Ankle Society ankle-hindfoot scale, they scored more than 90 points at the final follow-ups. Conclusion Reconstruction of lateral malleolus with a free iliac bone graft can lead to positive therapeutic effects and ideal long-term outcomes. Key words: Ankle; Wounds and injuries; Ilium; Reconstructive surgical procedures; Transplantation