Tibia Adaptation after Fibula Harvesting: An in Vivo Quantitative Study

Abstract

Absence of the fibula after harvesting to reconstruct an upper-limb segment increases loads on the donor-side tibia and thereby provides a unique opportunity to analyze the bone adaptation process in humans. We therefore quantified densitometric and morphologic changes of the donor-side tibia in three young patients (ages 8, 13, 16 years), on the basis of computed tomography (CT) examinations of both legs (one preoperatively and two postoperatively). The range of final followup was 27-43 months. Three-dimensional models of shank bones were generated from CT data and used to measure cross-sectional area, diaphyseal cortical thickness, and cross-sectional moment of inertia. In addition, density of the newly formed bone was evaluated. The donor-side tibia showed morphologic and density adaptation with time. New bone was deposited predominantly in the interosseous space and almost replaced the bone area lost by excision of the fibula. The second moment of area grew more in the donor-side tibia than in the intact one, without fully recovering the contralateral tibia-fibula complex values, and the principal axes rotated toward the preoperative direction. Thus, while considerable adaptation had occurred by 27-43 months in these young patients, the adaptation was incomplete; the mineral density of the newly formed bone recovered normal cortical bone values only in the patient with the longest followup (43 months). Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.