Fibular Length Research Articles

Limitations of Computed Tomography Angiography in Preoperative Planning of Peroneus Brevis Rotational Flap.

Twenty-five patients who underwent bilateral lower extremity CTAs using standard lower extremity protocol were retrospectively identified. Axial two-dimensional images were scanned craniocaudally using our institution's standard CT image viewing software, Merge Radsuite (Merge Healthcare, Hartland, Wis.). The average location of distal-most PB perforators identified on CT angiogram was 13.1 ± 5.1 cm proximal to the distal fibula, or 34.5% ± 13.5% of total fibular length. Standard CTA was only able to locate a pedicle within 8 cm of the lateral malleolus (20.9% of fibular length) in three of 25 patients (12%). Previous studies have described a reliable pedicle within 8 cm of the distal fibular tip upon which to design a distally based PB rotational flap. The absence of such perforators in the CT angiogram suggests that standard CT angiogram is not a reliable technique for identifying the patency of such perforators when evaluating the utility of a distally based PB flap.

Normal Fetal Growth Profile at 10-41 Weeks of Gestation - An Update Based on 10225 Normal Singleton Pregnancies and Measurement of the Fetal Parameters Using 3D Ultrasound.

To construct new growth charts and tables for the following fetal growth parameters: biparietal diameter (BPD), occipitofrontal diameter (OFD), head circumference (HC), abdominal transverse diameter (ATD), abdominal sagittal diameter (ASD), abdominal circumference (AC), femur length (Fe), tibia length (Ti), fibula length (Fi), humerus length (Hu), radius length (Ra), and ulna length (Ul). This prospective study was conducted at a level III ultrasound center as a population-based cross-sectional study on 10 225 normal singleton pregnancies with a gestational age between 10 and 41 completed weeks. Gestational age was confirmed in all cases by an ultrasound examination with crown-rump measurement before 10 weeks of gestation. All examinations were performed with 3 D probes. BPD, OFD, ATD, and ASD were measured as outer-to-outer measurements (skin-to-skin) after identifying the exact biometric planes by 3 D multiplanar display. HC was computed using the formula . For AC the approximate elliptical formula AC = (ATD+ASD)/2 × 3.142 was used. Measurements of the limb bones included the entire ossified shaft. Based on a nonlinear regression model for the age-specific mean values, distribution-free reference ranges were calculated for the parameters BPD, OFD, HC, ATD, ASD, AC, Fe, Ti, Fi, Hu, Ra and Ul. The new reference ranges were compared with our reference ranges published in 1996 as well as with different reference charts published by other authors. 3 D ultrasound allows a controlled demonstration of all fetal planes required for exact biometric measurements. The fetal growth profile including the 12 biometric parameters gives a precise overview of normal or abnormal fetal growth.

Examination of Anatomic and Morphometric Features of Kager’s Triangle

Abstract Background/aim: In this study, it was aimed to determine the morphometric properties of the Kager’s triangle, which is located in the posterior region of the ankle where interventional procedures are frequently performed and contains fat pad. Materials and methods: For our study, bilateral lower extremity of 4 female and 4 male cadavers were dissected. Tibia length, fibula length, foot length, intermaleolar length, intercondylar length, gastrocnemius muscle’s medial head and lateral head and tendon length, floor, anterior margin, posterior margin lengths and area of Kager’s triangle were measured in the cadavers. Descriptive and statistical analysis of the morphometric measurements we made was performed. Results: All 3 parts of the Kager’s triangle, which are defined anatomically in the literature, have been observed. The base of the Kager’s triangle is an average of 24.33±2.05 mm in women and 31.44±3.84 mm in men. The anterior border of Kager's triangle is 60.10±6.56 mm in females and 67.19±19.05 mm in males. The posterior border of Kager's triangle was found to be 55.61±6.38 mm in women and 72.52±17.56 mm in men. The area of Kager's triangle was found to be 6.74±1.15 cm² on average in females and 9.06±1.85 cm² in males. Conclusion: The data obtained will be a guide for the injections to be applied to the region or surgical interventions to be performed in the region, especially for the treatment of pathologies such as Achilles tendinopathy in this region. It is aimed that this study will contribute to the literature on the anatomy of the relevant region

Comparative result between adult men and women with ankle fractures surgically treated

Objective: Compare the results between adult men and women treated with open reduction and internal fixation after unstable ankle fractures. Methods: Prospective study including 86 patients (n=57, men; n=29, women) with unstable ankle fractures surgically treated. A sociodemographic and clinical questionnaire with 48 items was applied. The morphology of ankle fractures was analyzed according to the AO Foundation and Orthopaedic Trauma Association (AO/OTA) classification system. Results: Among the 86 patients, young men predominated all variables researched. The most common injury was motorcycle crashes, followed by soccer accidents (p≤0.001) caused by high-energy trauma (p≤0.05). Other factors are fractures on the right side (p≤0.05), more fractures AO/OTA 44-B2 and C1 (p≤0.05), and malleolus lateral and bimalleolar fractures (p≤0.01). Conclusion: The results indicate that adult men are more likely to suffer ankle fractures requiring surgical treatment than adult women. We suggest that the anatomical reduction of displaced malleolar fractures, especially restoring the fibula length and maintaining reduction until the fracture is healed, appears to be highly favorable for the surgical treatment of unstable ankle fractures. Level of Evidence II; Prognostic Studies; Prospective Study.

How to improve the biomechanical stability of endosteal augmentation for proximal humerus fracture with osteopenia? A cadaveric study

BackgroundEndosteal augmentation enhances the stability of osteoporotic proximal humeral fracture fixation, but the optimal configuration is unknown. The purpose of this study was to compare the biomechanical properties of different lengths of fibula with or without calcar screw in osteoporotic proximal humeral fracture. MethodsThree-part proximal humeral fractures with osteopenia were created on 20 pairs of fresh-frozen humeri specimens and allocated to four groups: (1) locking plate with a 6-cm fibular strut allograft, (2) locking plate with a 6-cm fibular strut allograft and additional calcar screws, (3) locking plate with a 12-cm fibular strut allograft，and (4) locking plate with a 12-cm fibular strut allograft and additional calcar screws. Specimens were loaded to simulate the force at 25° abduction. Thereafter, an axial stiffness test and a compound cyclic load to failure test were applied. Structural stiffness, number of cycles loaded to failure and relative displacement values for 5000 cycles at predetermined measurement points were recorded using a testing machine and a synchronized 3D video tracking system. FindingsIn terms of initial stiffness, number of cycles loaded to failure, and relative displacement values, the groups with 12-cm fibular strut showed obvious improvement compared to the groups with 6-cm fibular strut irrespective of the influence of calcar screw implementation. Further, the groups implemented with calcar screws also showed promising biomechanical stability irrespective of fibular length. InterpretationLateral locking plate with longer endosteal fibular augmentation and calcar screw can significantly improve biomechanical stability for elderly proximal humeral fractures with posteromedial comminution.

Single-Stage Reconstruction with Innate Chimeric-Free Fibula Flap in Limb-Preserving Excision of Upper Limb Sarcomas

IntroductionThe limb-preserving excision is the standard of care in upper limb sarcoma management, but the resulting complex composite defects are exacting the expertise of the reconstructive surgeons. This study was done to evaluate a novel single-stage reconstruction of these defects using an innate chimeric-free fibula flap (a nonfabricated, anatomically available multiple tissue components harvested on independent perforators arising from the same peroneal source vessel). Patients and MethodsTwenty patients (16 male/4 female) with an average age of 29.5 years with upper extremity sarcoma (Enneking IIA/IIB) were treated by wide local excision and innate chimeric-free fibula flap reconstruction from March 2012 to March 2020. All the patients were followed for an average period of 18.3 months. At the end of the follow-up, the outcome was assessed by musculoskeletal tumor score (MSTS). ResultsThe flow-through flap was done in five patients. Muscle-tendon unit defects were reconstructed with a vascularized peroneus longus muscle-tendon unit in 15 patients. Nerve gap reconstruction using vascularized superficial peroneal nerve was done in eight patients. All patients had a segmental defect in the appendicular skeleton that was reconstructed with the vascularized fibular strut component. Soleus chimeric muscle component was used as a void filler and for covering the hardware in seven patients. The average size of the chimeric cutaneous component paddle was 30.7 cm2. The average length of fibula used for reconstruction was 16.6 cm. All flaps survived well, facilitating good hand function at the end of the follow-up. The average outcome score as per the MSTS was 22 (p = 0.035). ConclusionThe innate chimeric-free fibula flap provides all tissue components facilitating a good functional outcome. The advantage is the restoration of a functional hand in a single-stage reconstruction.

Treatment of Symptomatic Subfibular Ossicle by Excision and Modified Broström Procedure for Skeletally Immature Patients.

Ossicle resection combined with ligament repair using the modified Broström procedure (MBP) is generally associated with favorable results in adults with symptomatic subfibular ossicles; however, the surgical results of this approach in skeletally immature patients remain unclear. The purpose of this study was to investigate the midterm clinical outcomes and radiographic outcomes including leg length and physeal growth of skeletally immature patients after this procedure. Twenty-six consecutive skeletally immature patients who underwent ossicle resection combined with the MBP were retrospectively evaluated. Clinical scores were evaluated using the visual analog scale (VAS), American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot score, Karlsson-Peterson score, and Tegner score. The talocrural angle, fibular length on radiographs, and tape-measured leg length between the 2 ankles were also measured at the final follow-up. Time of return to sports and postoperative complications were also evaluated. Fourteen girls (53.8%) and 12 boys (46.2%) had surgery at a mean age of 12.7±2.4 years. Mean postoperative follow-up time was 40.0±10.8 months. Mean VAS pain score improved from 4.1 preoperatively to 0.5 at final follow-up (P < .05). Mean AOFAS score, Karlsson score, and Tegner score all improved from 62.0, 54.0, and 2.8 preoperatively to 95.5, 94.0, and 5.4 (P < .05), respectively, at final follow-up. Median time of return to sports was 17.0 weeks. Mean talocrural angle, fibular length, and tape-measured leg length of the injured ankle were not significantly different from those of the contra-side at the final follow-up. All patients were satisfied with the results; repeat ligamentous injury occurred in 2 patients (7.7%). We had no cases of wound infection, nerve injury, compartment syndrome, or any other complications. Ossicle resection combined with the MBP performed in skeletally immature patients with symptomatic subfibular ossicles resulted in improved clinical outcomes without disruption of fibular physeal growth by an average of 3.3-year follow-up. Level IV, case series.

Restoration of Anatomic Parameters and Syndesmotic Reduction After Intramedullary Nailing of Distal Fibular Fractures

Intramedullary nailing of the fibula (FN) is a method of fixation that has proven to be useful for treating distal fibular fractures (DFs). FN minimizes soft tissue complications and provides similar stability to plating, with fewer hardware-related symptoms. Nevertheless, FN has been associated with syndesmotic malreduction and the incapacity of restoring length and rotation of the fibula. We aimed to evaluate the fibular position and syndesmotic reduction after fixation with FN compared with the uninjured ankle in the immediate postoperative period. Prospective cohort study. Patients with DF fractures treated with IN between January 2017 and January 2020 were included. Immediate postoperative bilateral ankle CT was obtained in all cases. Fibular rotation, length, and translation as well as syndesmotic diastasis were measured on both ankles and compared by 3 independent observers. Twenty-eight patients were included (16 women). The mean age was 46 years (range 16-91). Fracture type distribution according to AO/ASIF classification included 19 patients with 44.B (67.9%), 8 patients with 44.C (28.6%), and 1 patient with a 44.A fracture (3.6%). No significant differences were identified considering fibular rotation (P = .661), syndesmotic diastasis (P = .147), and fibular length (P = .115) between the injured and uninjured ankle. Fibular translation had statistical differences (P = .01) compared with the uninjured ankle. The intraclass correlation coefficient showed an excellent concordance between observers except for fibular translation on the injured ankle. In this cohort, fixation of DF fractures with FN allows restoration of anatomical parameters of the ankle in terms of fibular rotation, length, and syndesmotic diastasis. However, fibular translation had significant differences compared with the uninjured ankle based on bilateral CT scan evaluation. Level II, prospective cohort study.

Surgical Fixation of Maisonneuve Fractures with a Screw Suture Fixation Device: Results of 10 Cases

Category: Trauma; Ankle; Sports Introduction/Purpose: Maisonneuve fractures consist of a fracture of the fibula in the proximal third with associated syndesmotic injury. Surgical management generally involves restoration of fibula length, reduction of the syndesmosis, and stabilization of the syndesmosis. Flexible fixation devices have gained popularity for syndesmotic fixation over the last several years. Current flexible fixation devices are not reliable for fixation of length unstable patterns of injury, like the Maisonneuve fracture. The purpose of the study was to evaluate the results of a new screw- suture syndesmotic device providing aperture fixation of the syndesmosis for fixation of Maisonneuve fractures. Methods: 10 consecutive patients with Maisonneuve injuries were treated with indirect restoration of fibula length, open reduction of the syndesmosis, and stabilization of the syndesmosis with the screw suture device. Talocrural angle and medial clear space was measured and recorded at time of injury, post operatively and 6 months. Rate of hardware removal was recorded.***2 patients are 2 months short of 6 months. both have healed their proximal fibula fractures so no changes to data are anticipated *** Results: There were 5 males and 5 females. 5 patients slipped on ice, 4 patients fell on uneven walking surfaces, 1 patient was in a motorcycle accident. 2 patients had associated posterior malleolus fractures, 1 was fixed with a posterior plate. 1 patient had a medial malleolus fracture repaired with 2 screws. 9 devices were placed independently. 1 device was inserted through a 4 hole 1/3 tubular plate. Average time to surgery was 12.3 days (range 5-24 days). Talocrural angles averaged 8.92 (4.8-14.5mm) on injury films, 13.8mm (10.6-17mm) post operatively and 13.5mm (10.6-16.6) at 6 months. Medial clear space measurement averaged 5.68mm (2-10mm) on injury films, 2.06mm (1.9-2.3mm) post operatively and 2.1mm (2-2.3mm) at 6 months. No devices required removal during the study period. Conclusion: The screw-suture device provided length stable fixation for treatment of Maisonneuve fracture patterns.

Factors Influencing Common Fibular Nerve Course Variability before Bifurcation into the Superficial Fibular Nerve and Deep Fibular Nerve: A Cadaveric Study

Background and Objectives: The common fibular nerve (CFN) has anatomical variance between individuals as it transitions from the posterior thigh to the anterior leg. The nerve’s course around the fibular neck is of particular interest, where it becomes vulnerable to injury at the lateral knee. Therefore, we sought to compare factors that may predict distal CFN variability, such as height, age, sex, fibular length, and proximal sciatic variations, which individually or cumulatively play a role in predicting clinically significant locations where the CFN commonly transitions among certain populations. Methods: In this cadaveric study, twenty anatomically-fixed specimens were analyzed, ten males and ten females. Data gathered included age, sex, height, CFN transition point measured from the proximal head of the fibular to the point 90 degrees off the midline of the fibula where the CFN courses around the fibular neck, fibular length, and proximal sciatic nerve variations characterized based on the Beaton and Anson classification system. Factors were compared and statistical values were generated. Results: There was a statistically significant difference between CFN transition points compared to fibular lengths, heights, and between sexes. Sciatic nerve (SN) bifurcation levels and exits were bilaterally identical on all cadavers. All SN exits were Beaton and Anson type 1 (undivided nerve below and undivided piriformis), and bifurcation levels were 20% high, 25% middle, and 55% low. Conclusions: This study highlights the importance of considering a person’s height, fibular length, and sex when addressing injuries involving the CFN at the lateral leg.

Relationships of the Ulna-to-fibula Ratio to Baseline and Reactive Steroid Hormone Levels: An Exploratory Study

ObjectiveOrganizational hormone effects on the human brain and behavior are often retrospectively assessed via morphological markers of prenatal (e.g., 2D:4D digit ratio) or pubertal (e.g., facial width-to-height ratio, fWHR) hormone exposure. It has been argued that markers should relate to circulating hormones particularly in challenging, dominance/status-relevant situations. However, meta-analytic research indicates that fWHR, a frequently used pubertal marker, is neither reliably sex-dimorphic nor related to steroid hormones. This casts doubt on fWHR’s validity for reflecting hormone levels. Ulna-to-fibula ratio (UFR), an alternative, long-bone-length-based pubertal marker, is sex-dimorphic and associated with dominance motivation. However, its hormonal associations were never tested before. We therefore explored UFR’s relationships to baseline and reactive hormone levels.MethodsWe measured ulna and fibula length as well as shoulder/waist/hip circumference of 81 participants (49 women; after exclusions) via anthropometry. Salivary hormone levels (estradiol, testosterone) at baseline and after a gross-motor one-on-one balancing contest were measured via radioimmunoassay.ResultsWe replicated UFR’s dimorphism, unrelatedness to height, and correlations to other putative markers of organizational hormone effects. On an exploratory basis, we found UFR to be related to overall baseline testosterone and to competition-induced reactive surges in steroid hormones (estradiol, testosterone) overall and in women.ConclusionsOur results hint at UFR’s relationship to baseline testosterone and may indicate functional connections between outcomes of pubertal organizational hormone effects and contest-induced steroid reactivity. Pubertal organizational hormone effects may prepare the endocrine system for dominance and status contests. However, the small sample and the exploratory nature of our research demands replication.

Analysis of related factors of long-term complications after vascularized fibular transplantation.

Free fibula flap is the first choice for jaw reconstruction in head and neck oncology, but postoperative complications in donor site are ignored always. The main purpose of this study was to investigate the long-term complications and potential risk factors of donor site after vascularized fibular transplantation, and to explore the precautions of preparing vascularized fibular flap and the measures of preventing donor site complications. Data were retrospectively collected on 31 patients who had undergone immediate mandibular reconstruction with a fibular flap after segmental mandibulectomy from 2013 to 2018 in Shanghai Ninth People's Hospital. Thirty-one patients (24 male, 7 female) were available for the long-term complications in donor site analysis from 25 to 96months after surgery. The data were collected and analyzed, including age at time of operation, early postoperative complications, incidence of dorsiflexion weakness of hallux, donor site missing fibula length, proximal and distal stump fibula length, and subjective evaluation of foot function (AOFAS-hallux, AOFAS-ankle hindfoot, Enneking lower limb function score). In the single-factor analysis in this study, the correlation between related factors and long-term complications was statistically analyzed. For inter-group comparisons of quantitative data, if the normal distribution was satisfied, two independent sample t-tests were used; p < 0.05 was statistical significant. If the normal distribution was not satisfied, Wilcoxon rank-sum test was used, and p < 0.05 was considered statistically significant. For qualitative data, the Fisher exact probability method was compared between group differences, and p < 0.05 was statistically significant. The most commonly encountered complication in our series was dorsiflexion disorder, flexion deformity, numbness of the lateral side of the lower leg, and dorsum of the foot. Ten patients (32.26%) developed hallux flexion deformity after operation, 17 patients (54.84%) had hallux dorsiflexion dysfunction after operation, and 10 patients (32.26%) had numbness of the lateral side of the lower leg and dorsum of the foot. The incidence of hallux dorsiflexion dysfunction, thumb flexion deformity, and sensory disturbance was higher than that of other long-term complications in the donor area. The residual length of fibular distal was related to the dorsiflexion dysfunction and flexion deformity of hallux (p < 0.05). The early complications of donor site were correlated with the hallux dorsiflexion dysfunction (p < 0.05). The incidence of dorsiflexion disorder and flexion deformity is higher in patients after fibula transplantation. The less the residual length of fibular distal, the more obvious the long-term complications in the donor site, and the higher the incidence of dorsiflexion dysfunction and flexion deformity of hallux. The long-term complications of donor site after fibular transplantation seriously affect the quality of life of patients and provide clinical reference for further reducing the occurrence of donor site complications.

Open Reduction and Fixation of Lateral Malleolus and Syndesmosis for Ankle Re-Fracture

Rotational ankle fractures are often accompanied with a syndesmotic injury. Furthermore, malreduction of syndesmosis and fibular shortening are frequent errors observed in these cases and often lead to poor functional outcomes. We present a case of Weber C lateral malleolus fracture and distal tibiofibular syndesmotic injury in an active 23-year-old patient. Various techniques for syndesmotic reduction and restoration of fibular length are discussed and demonstrated.

The Influence of Parents’ Education on Growth Pattern of Children Aged 5-12 Years From Kazaure Emirate, Jigawa State, Nigeria

Anthropometry is defined as the measurements of different parts of the body and is widely used in surveys as an indicator of nutritional and health status. Studies revealed that large number of socio-economic variables are associated with the physical development of children. These variables consist of parental profession, income, education, birth order, family size, and urbanization. Materials used for the study were Stadiometer, non-elastic measuring tape, Skin fold caliper. The study involved a cross-sectional survey comprising of 863 pupils randomly selected from public primary schools in Kazaure emirate. The subjects were noted for sex and age. A stadiometer was used to measure height to the nearest 0.1 cm and weight to the nearest 0.5 kg. A non-elastic measuring tape was used for the measurement of head, neck, chest, mid upper arm, hip, waist and calf circumferences to the nearest 0.1cm respectively. A Harpenden skin fold caliper was used for the measurement of biceps and triceps skin fold thicknesses to the nearest 0.1 mm respectively. The study participants were apparently healthy public primary school pupils aged between 5 - 12years, from Kazaure Emirate and ofHausa ethnic group (parents and grandparents are Hausa). Based on lack of parents’ formal education, males had higher values of neck circumference (NC) and chest circumference (CTC) than females with statistical difference at p&lt;0.05. However,females had higher values ofcephalic index (CI) than males with statistical difference at p&lt;0.05.Based on the level of education of parents (primary, secondary and tertiary education), males had higher values of height (HT), weight (WT), BMI, head circumference (HDC), NC, CTC, waist circumference (WC) and calf circumference (CC) than females with statistical difference at p&lt;0.05. However, females showed higher mean values of triceps skinfold thickness (TSF) and hip circumference (HC) than males with statistical difference at p&lt;0.05. Males had higher values ofhead length (HDL), head breadth (HDB), facial length (FL) and facial breadth (FB) than females with statistical difference at p&lt;0.05. Conversely, females showed higher mean value ofcephalic index (CI) than males with statistical difference at p&lt;0.05.Males had higher values of right humerus length (RHML), left humerus length LHML), right ulna length (RUL), left ulna length (LUL), right radial length (RRL), left radial length (LRL), right hand length (RHNL), left hand length (LHNL), right hand breadth (RHNB) and left hand breadth (LHNB) than females with statistical difference at p&lt;0.05. Males had higher values of right tibial length (RTBL), left tibial length (LTBL), right fibula length (RFBL), left fibula length (LFBL), right foot length (RFTL), left foot length (LFTL), right foot breadth (RFTB) and left foot breadth (LFTB) than females with statistical difference at p&lt;0.05.

Morphological Variation and Distribution of Honeybees Apis Mellifera (L) Across Altitudinal Gradient in Selected Areas of Tanzania

The study aimed at determining morphological variations and distribution of honeybee populations along altitudinal gradient of Tanzania. Samples of the honeybees were collected from 93 feral colonies from sea level to 3000m above sea level. Twenty characters from right hind legs and forewings were measured for morphometric analysis. The descriptive analysis of the same characters by both Principal Component Analysis (PCA) and Discriminant Factor Analysis (DFA) showed weak correlation with altitude. On the other hand, Analysis of Variance (ANOVA) of the 20 characters indicated that only 45% of the characters had significant variations. Among the measured parameters, only wing distance L4 and fibula length (FL) varied in all populations. Characters L2, D7, E9 and O26 varied significantly (P&gt;0.05) only between populations 1 and 2; and character L3 between populations 2 and 3. Besides, there was high overlap in both scattergram and visualization space analyses, suggesting increased intermixing among the populations. However, a further study by using other analytical tools such as molecular analysis was required. Keywords : Morphological Variation, Distribution, Honeybees DOI: 10.7176/JBAH/12-12-04 Publication date: June 30 th 2022

Lower leg symmetry: a Q3D-CT analysis

PurposeIn fracture and realignment surgery, the contralateral unaffected side is often used as a model or template for the injured bone even though clinically valuable quantitative data of bilateral symmetry are often unavailable. Therefore, the objective of the present study was to quantify and present the bilateral symmetry of the tibia and fibula.MethodsTwenty bilateral lower-leg CT scans were acquired in healthy volunteers. The left and right tibia and fibula were segmented resulting in three-dimensional polygons for geometrical analyses (volume, surface and length). The distal and proximal segment of the right tibia of each individual was subsequently matched to the left tibia to quantify alignment differences (translation and rotation). Bone symmetry on group level was assessed using the Student’s t test and intra-individual differences were assessed using mixed-models analyses.ResultsIntra-individuals differences were found for tibia volume (5.2 ± 3.3 cm3), tibia surface (5.2 ± 3.3 cm2), translations in the lateral (X-axis; 9.3 ± 8.9 mm) and anterior direction (Y-axis; 7.1 ± 7.0 mm), for tibia length (translation along Z-axis: 3.1 ± 2.4 mm), varus/valgus (φz: 1.7o ± 1.4°), and endotorsion/exotorsion (φz: 4.0o ± 2.7°).ConclusionThis study shows intra-individual tibia asymmetry in both geometric and alignment parameters of which the surgeon needs to be aware in pre-operative planning. The high correlation between tibia and fibula length allows the ipsilateral fibula to aid in estimating the original tibia length post-injury. Future studies need to establish whether the found asymmetry is clinically relevant when the contralateral side is used as reference in corrective surgery.Level of evidenceIII cohort study.

An anatomic study of the perforators from the peroneal artery. A new method to locate the cutaneous perforator

BackgroundThe goal of this study was to investigate the anatomy of the perforators from the peroneal artery in Vietnamese patients. Methods30 cadaver's legs were dissected and investigated for the distribution, course, origin, number and types of perforators of the peroneal artery. The locations of the exit points on the skin of perforators were marked in relation to reference points and segments. ResultsThe total number of cutaneous perforating branches of the peroneal artery from 30 specimens was 149, which included 63 (42.2%) musculocutaneous perforators and 86 (57.8%) septocutaneous perforators. In most cases, the perforator branches were located in the range from 4 to 7 of the total fibula length (69.8%). The average number of perforating vessels in a leg was 4.9, ranging from 1 to 8 vessels. All the perforators were positioned behind the posterior border of the peroneal bone. In all the dissected samples presented, there was always one cutaneous perforator within a distance of 18 mm from the F point, which is the junction between the 6/10 and 7/10 segments at the posterior border of the fibular bone. ConclusionThe abundance of cutaneous perforators in Vietnamese patients can be used to plan various combined skin and bone flaps. A cutaneous perforator was consistently found near the F point, and this factor can be used in the planning of a bone flap with accompanying skin for monitoring survival of the underlying fibular bone flap.

THE ANTHROPOMETRY RELATIONSHIP LONG BONE TO HEIGHT OF BATAK TOBA TRIBE STUDENT IN BEKASI CITY

Forensic anthropology is the application of a specific branch of biological anthropology based on human bones and anatomy. Anthropometry is a method of measuring body parts. Height measurement is a forensic anthropological parameter that helps build a person's biological profile. Height can be determined by the size of the long bones including the humerus, radius, ulna, femur, tibia, and fibula. This research on height was carried out on Batak Toba students. This study aims to determine the anthropometric relationship of long bone length to the height of Batak Toba students in the city of Bekasi. This research is an analytic observational study with a cross sectional approach. This research was conducted in the city of Bekasi with the research subjects totaling 60 students consisting of 30 men and 30 women with an age range of 18-22 years from the Toba Batak tribe who did not have bone disorders. Samples were taken by purposive sampling technique. Data analysis was performed by Pearson Correlation (r) test. The parameters analyzed in this study were length of humerus, radius, ulna, femur, tibia, fibula, height, sitting height, weight, and body mass index. The results of the Pearson Correlation test analysis (r) showed that there is a significant relationship between the length of the humerus, radius, ulna, femur, tibia, fibula and sitting height with a strong to perfect correlation, while the relationship between body mass index and height there is no significant difference and there is no correlation to Batak Toba students in the city of Bekasi.&#x0D; Keywords: height, long bones, anthropometry, Batak Toba

Optimal location for fibular osteotomy to provide maximal compression to the tibia in the management of delayed union and hypertrophic non-union of the tibia

BackgroundTibial shaft fractures are the commonest long bone fracture, with early weight-bearing improving the rate of bony union. However, an intact fibula can act as a strut that splints the tibial segments and holds them apart. A fibular osteotomy, in which a 2.5 cm length of fibula is removed, has been used to treat delayed and hypertrophic non-union by increasing axial tibial loading. However, there is no consensus on the optimal site for the partial fibulectomy. MethodsNine leg specimens were obtained from formalin-embalmed cadavers. Transverse mid-shaft tibial fractures were created using an oscillating saw. A rig was designed to compress the legs with an adjustable axial load and measure the force within the fracture site in order to ascertain load transmission through the tibia over a range of weights. After 2.5cm-long fibulectomies were performed at one of three levels on each specimen, load transmission through the tibia was re-assessed. A beam structure model of the intact leg was designed to explain the findings. ResultsWith an intact fibula, mean tibial loading at 34 kg was 15.52 ± 3.26 kg, increasing to 17.42 ± 4.13 kg after fibular osteotomy. This increase was only significant where the osteotomy was performed proximal to or at the level of the tibial fracture. Modelling midshaft tibial loading using the Euler-Bernoulli beam theory showed that 80.5% of the original force was transmitted through the tibia with an intact fibula, rising to 81.1% after a distal fibulectomy, and 100% with a proximal fibulectomy. ConclusionThis study describes a novel method of measuring axial tibial forces. We demonstrated that a fibular osteotomy increases axial tibial loading regardless of location, with the greatest increase after proximal fibular osteotomy. A contributing factor for this can be explained by a simple beam model. We therefore recommend a proximal fibular osteotomy when it is performed in the treatment of delayed and non-union of tibial midshaft fractures.

Predictive value of different body segments to estimate height in a South African adult hospital population.

Height measurement is a vital component for assessing nutritional risk, and calculating dietary requirements in a clinical setting where indirect calorimetry is not available. In many patients, height cannot be measured accurately, and equations based on body segments are relied on to predict height. This study aimed to evaluate if specific body segments are better associated with height than others in a South African public hospital setting. A descriptive cross-sectional study was conducted in three public hospitals in Bloemfontein, South Africa, on patients, 20-50 years of age, and able to stand upright without assistance to be measured by stadiometer. Spearman correlations were assessed between stadiometer height and arm-span, demi-span, ulna length, knee height, tibia length, fibula length and foot length (measured by standardised techniques). Multiple regression analysis was performed to identify the segment that is most closely associated with stadiometer height in the study population. The sample included 141 participants (61.7% male, median age 38.8 years; IQR: 10.1 years). All measured body segment were statistically significantly correlated with stadiometer height, the strongest association being with knee height in both males (R2:0.77) and females (R2:0.86). Foot length and ulna length had the weakest correlation with stadiometer height in males and females, respectively. Multiple regression analysis identified knee height as having the best predictive value in determining stadiometer height. Overall, measurements of lower leg segments, particularly knee height, predicted measured height better than upper body segments. When choosing height-prediction equations in clinical settings in populations with a high prevalence of stunting, such as South Africa, the fact that stunting affects the growth of long bones in the lower body more than in the upper body, should be considered.