Distal Tibiofibular Synostosis Research Articles

Isolated Congenital Pseudoarthrosis of the Fibula

Isolated congenital pseudoarthrosis of the fibula is associated with progressive ankle valgus and rare subsequent tibial involvement. Two operative techniques were compared: (1) osteosynthesis with intercalary grafting and (2) distal tibiofibular synostosis. Hemiepiphysiodesis or osteotomy supplemented the primary procedure when necessary. A retrospective review of isolated congenital pseudoarthrosis of the fibula-Dooley types 2 (without ankle valgus) and 3 (with ankle valgus); cases with tibial involvement (Dooley types 1 and 4) were excluded. Nine patients were identified (mean age, 7.6 years, follow-up, 6.6 years). One is under observation without bracing (type 2). Five patients (one type 2 and four type 3) were treated with osteosynthesis. Three were treated with distal tibiofibular synostosis (one type 2 and two type 3). One patient in each group also underwent concomitant medial distal tibia hemiepiphysiodesis; 1 patient in the synostosis group underwent distal tibia varus osteotomy with the primary procedure. In the osteosynthesis group (5 patients), mean lateral distal tibial angle (LDTA) improved from 75.6 to 86.6 degrees. Union was achieved in 4; 1 had early graft resorption requiring revision. Four of the 5 had neutral ankle alignment at the final follow-up. Among the 3 patients with primary union and no deformity correction, mean LDTA improved from 81 to 88 degrees over 9.8 years of follow-up. One patient had mild residual valgus (LDTA, 79 degrees) after temporary screw hemiepiphysiodesis. Complications were as follows: nonunion (n = 1), compartment syndrome with mild residual plantar flexion weakness (n = 1), and fibular stress fracture, which healed with immobilization (n = 1).In the synostosis group (3 patients), the mean LDTA improved from 64.3 to 80.0 degrees. One achieved union with distal tibia medial hemiepiphysiodesis (final LDTA, 86 degrees). Two had failure: one synostosis nonunion underwent repeat varus osteotomy (final LDTA, 81 degrees), and the other (Dooley type 2) had crossunion; however, persistent fibular pseudoarthrosis proximal and distal to the synostosis, progressive valgus developed (final LDTA, 73 degrees). Osteosynthesis with intercalary grafting achieved primary union in 4 of 5 patients; mild residual ankle valgus was present in 1 patient at final follow-up. Synostosis failure with residual ankle valgus at maturity occurred in 2 of 3 patients. Progression to tibial pseudoarthrosis was not observed in either group. In this series, osteosynthesis eliminated fibular discontinuity, allowing correction of ankle valgus. Level III, retrospective comparative study.

Congenital Distal Tibio-fibular Synostosis - Case Report -

Congenital distal tibio-fibular synostosis is a very rare disease with no reported cases in Korea. An 8 year old girl complained of ankle discomfort and deformity due to distal tibio-fibular synostosis. The patient was treated with an autogenous fat graft after a bone bridge resection and fibular osteotomy to restore the ankle mortise. Osteosynthesis with a plate was performed to treat the fibular nonunion during the follow-up. Fibular union was achieved, and there have not been any subjective symptoms or limitations of outdoor activity and ROM during a four and half year follow up.

Isolated Congenital Pseudarthrosis of the Fibula

The purposes of this study were to determine the clinical course of isolated congenital pseudarthrosis of the fibula (ICPF) and to establish optimal treatment guidelines for this disease. Thirteen fibulae in 12 patients with ICPF were followed for an average of 6.2 years. Twelve of the 13 fibulae were regarded to originally have had a pre-pseudarthrotic condition. Five fibulae remained intact during follow-up, but 8 developed pseudarthrosis. Two cases with established pseudarthrosis were observed for ankle alignment change without intervention, and in 4 cases successful fibular osteosynthesis maintained the ankle alignment. The remaining 2 adolescent cases presenting with ankle valgus were treated using the Ilizarov technique and distal tibiofibular synostosis. ICPF follows a unique clinical course, which should be taken into consideration along with fibular status, ankle alignment, and patient age when planning treatment.

Outcome Results of Ilizarov Osteosynthesis for Congenital Pseudarthrosis of the Tibia: An Interim Report

Purpose : This study evaluated the efficacy of the Ilizarov technique for the treatment of patients with congenital pseudoarthrosis of the tibia (CPT). Material and Methods : Twenty-two patients with CPT, who underwent osteosynthesis using the Ilizarov technique and were followed-up for more than 3 years, were enrolled in this study. The clinical and radiological data were reviewed to evaluate the outcomes of the Ilizarov technique. Results : The initial osteosynthesis was carried out successfully with the Ilizarov method at average age of 4.6 years. Twenty refractures occurred in 12 patients, who were also treated successfully using the Ilizarov method. Tibial lengthening (27 cases), medial tibial hemiepiphysiodesis (23 cases), distal tibiofibular synostosis (17 cases) were combined with a total of 42 Ilizarov osteosyntheses. After an average 8.1 years follow-up, the mean limb length discrepancy was 1.6 cm, and average anterior apex and valgus angulation of the tibial shaft were 6.3˚ and 7.3˚, respectively. The mean ankle alignment was valgus 1.9, and the mean range of motion of the ankle joint was 21˚ dorsiflexion and 33˚ plantar flexion. Conclusion : The Ilizarov technique combined with tibial lengthening, distal tibiofibular synostosis and/or medial tibial hemiepiphysiodesis is an effective procedure that can achieve bony union as well as a functional limb.

Post-Traumatic Tibio-Fibular Synostosis in Adults

Die posttraumatische tibio-fibulare Synostose (PTFS) ist eine seltene Komplikation nach Schienbein- und Knöchelfrakturen. Distal werden Synostosen am häufigsten beobachtet, sie kommen aber auch im mittleren und poximalen Drittel vor. Die proximal gelegenen Synostosen sind auf Nativröntgenbildern schwierig, im CT jedoch leicht zu entdecken. Fünfzehn Patienten (5 Frauen, 10 Männer) mit PTFS wurden nachuntersucht. Ihr Alter beim initialen Trauma lag zwischen 18 und 57 Jahren, im Mittel bei 35,9 Jahren. Der Nachuntersuchungszeitpunkt lag zwischen 2 und 22 Jahren, im Mittel 5,2 Jahre nach Trauma. Die meisten Patienten beklagten Schmerzen und/oder Bewegungseinschränkung im oberen Sprunggelenk. Die milde Beschwerdesymptomatik und leichte bis moderate Bewegungseinschränkung rechtfertigten eine Resektion der Knochenbrücke nicht. Arthrosezeichen wurden auf den aktuellen Röntgenbildern nicht gefunden. Schlussfolgerung: Auch symptomatische Patienten mit PTFS sollten konservativ behandelt werden.

Tibialization of the Fibula

I retrospectively reviewed 21 patients who had tibialization of the fibula for infected nonunions with scarring of soft tissues. Most of the patients had unsuccessfully had other operations to restore continuity of the tibia before this treatment. The prerequisites were adequate vascularity, an intact sensate sole, and intact fibula. Proximal site tibiofibular synostosis was done in all patients. Three patients required a supplementary procedure at the proximal tibiofibular junction because of screws cutting out. Distal tibiofibular synostosis was done as a second-stage procedure in a majority of the patients 3 to 6 weeks after the proximal procedure. Protected weightbearing was recommended for 4 to 8 months. The transplanted fibula hypertrophied and approached the diameter of the tibia (or double the size of original fibula) in 2-3 years. Tibialization of the fibula is a safe, nondestructive, salvage procedure for treating difficult infected nonunions of the tibia. It is a simple technique that can be done in hospitals with a moderate infrastructure. Despite scarring, shortening, and limitation of knee and ankle motion, the patients were satisfied to be able to take part in normal daily activities on their own. After the success of synostosis, all patients engaged in activities of daily living and during the followup of 4-14 years none developed stress fracture of the tibialized fibula.

Distal tibiofibular synostosis after ankle fracture

目的 研究下胫腓骨性连接对患者的症状和功能的影响,并探讨其对临床工作的启发.方法对14例术后出现下胫腓骨性连接的踝关节骨折的患者(共14踝)进行平均22.8个月(11～54个月)随访,采用Philips等踝关节临床评分系统对随访结果评分.结果主观症状:除3例患者主诉在长时间行走或劳动后有一过性酸痛外,其他病人均无不适主诉,所有患者均无明显生活或工作障碍;踝关节功能:跖屈平均为47.9°,较健侧差3.5°(0～10°),背伸平均为20°,较健侧差8.6°(0～20°);所有病人的X线片上均无明显骨性关节炎表现;Philips等踝关节临床评分平均为90.8分(82～98分),其中优71.4%,优良率100%.结论骨折后形成的下胫腓骨性连接通常不会引起明显的症状和功能障碍,一般无需进一步治疗。

DISTAL TIBIOFIBULAR SYNOSTOSIS AFTER ANKLE FRACTURE

Over an eight-year period up to 1983, a total of 322 consecutive patients had operations for ankle fractures; 176 were Weber type B and 128 type C. We were able to review 230 of these patients after a mean follow-up of six years (1 to 11) including 128 with Weber B and 102 with Weber C fractures. We used an ankle score which combined symptoms and clinical and radiological findings, with a maximum score of 100 points. The mean score for all 230 was 92 (68 to 100). Fifteen of these patients had developed a distal synostosis between the tibia and fibula, three after a Weber B and 12 after a Weber C fracture. In 13 of these 15 ankles the synostosis had been visible radiologically within three months of the operation. In the other two there had been radiologically visible calcification at the three-month follow-up. In 1993, we were able to review nine of the 15 patients with synostosis using the same scoring system. At a mean follow-up of 14 years (12 to 18) the mean score for those with synostosis was 91 (71 to 100), much the same as this group's previous score and the mean score of the whole group of operated patients. We conclude that distal tibiofibular synostosis after ankle fracture usually causes few symptoms and does not generally require any treatment.

Open Ankle Fractures

Twenty-two patients with open ankle fractures or fracture-dislocations were treated with irrigation and debridement, reduction, and immediate stable internal fixation at an average of six hours from initial evaluation. There were 13 women (59%) and nine men (41%), having an average follow-up period of 32 months (range, five to 111 months). There were six Grade I (27%), 15 Grade II (68%), and one Grade III (5%) injuries. Fractures also were classified according to the Danis-Weber scheme (Type A [three cases]; Type B [eight]; Type C [11]). Excellent results were achieved in 14 patients (64%); good results in five (23%), and poor results in three (13%). There were four minor complications: two superficial would ulcerations, one loss of reduction requiring revision stabilization, and one distal tibiofibular synostosis. There were no deep infections or nonunions. Immediate debridement, irrigation, reduction, and internal fixation of open ankle fractures is clearly indicated in Grade I and clean Grade II open injuries.

Fibular Stress Fracture Associated With Distal Tibiofibular Synostosis in an Athlete

A 19-year-old collegiate football player with progressive ankle syndesmosis ossification developed acute localized fibular tenderness. Roentgenograms demonstrated a fibular stress fracture proximal to the superior extent of the ossific mass. Surgical resection of the mass resulted in uneventful fibular healing, with resolution of acute and chronic symptoms.

Distal tibiofibular synostosis due to direct trauma

Tibiofibular synostosis is a rare cause of disability. We describe an unusual case occurring after a direct blow to the lower leg which resulted in severe symptoms and which recurred after surgical excision

Stabilization of ankle syndesmosis injuries with a syndesmosis screw.

A retrospective review was made of 30 patients who had disruption of the ankle syndesmosis that was treated at Santa Clara Valley Medical Center with a transfixation screw. Follow-up ranged from 3 months to 3 years. There were 21 pronation external rotation injuries and 9 Maison-neuve fractures. Screw size ranged from 3.5 cortical to 6.5 cancellous Synthes screws. Most were placed transversely from 1.5 to 3.5 cm above the joint line. Intraoperative difficulties with screw placement occurred in 2 patients, resulting in one bent screw and one screw placed directly into the ankle joint. Most patients were mobilized prior to screw removal; lucent lines developed around the syndesmosis screw before it was removed in two-thirds of the patients. No screw broke prior to removal. In 6 patients, calcification of the interosseous membrane was seen and, in 4, this progressed to a distal tibiofibular synostosis. It was found that transfixation screws provided satisfactory stability of the syndesmosis to permit stable healing of the interosseous membrane and distal ligaments after ankle fracture. Motion between the tibia and fibula developed despite screw fixation, as shown by the lytic bony changes that occurred with time.