Fibular Transposition Research Articles

Evaluation of the efficacy of ipsilateral fibular transfer for reconstruction of large tibial defects in children: a retrospective study

BackgroundReconstruction of large tibial defects is often a major challenge in limb salvage. This study aimed to evaluate initial follow-up results of ipsilateral fibula transfer for the treatment of large tibial defects in children.MethodsA retrospective study was performed between September 2014 and April 2021. Ten children were identified as having large tibial defects. The children underwent ipsilateral fibula transfer. We then evaluated initial healing, tibial length discrepancy, ankle varus/valgus, fibular position, refracture, infection, and function.ResultsFive boys and five girls, with an average age of 7.2 years, were evaluated. The transferred fibula was united in the patients. The mean follow-up period after fibular transposition was 43 months. The patients achieved primary bone union; the mean time to union was 8.4 months (range, 4–18 months). Complications included refracture (30%), infection (40%), tibia malunion (30%), ankle varus (30%), sensory loss of toes (10%), and ankle valgus (10%). No other major complications were observed. All 10 patients were able to perform activities of daily living and return to their normal activities.ConclusionIpsilateral fibula transfer is a salvage surgery for the treatment of large tibial defects in children with congenital pseudoarthrosis of the tibia, traumatic nonunion of the tibia, and/or tibial defect after chronic osteomyelitis. However, long-term results still need to be followed up.

Huntington's procedure revisited

BackgroundManagement of gap nonunion of tibia is difficult for the surgeons, and time consuming for patients with unpredictable results. There are various methods to treat gap nonunion, but each one has its own limitations. We report the outcomes of ipsilateral fibular transposition (Huntington's procedure) for reconstruction of major tibial defects. MethodsIt is a retrospective study including 4 patients who underwent ipsilateral vascularized transposition of fibula for gap nonunion of tibia. Fibula was transferred to tibia as vascularized pedicle graft in one-staged procedure. ResultsSingle stage fibular transposition was performed in four patients. The transferred fibula united in all patients. Mean follow-up after fibular transposition was 1.2 years. Partial weight bearing started after an average of 5.25 months till hypertrophy of fibula is seen on radiographs than full weight bearing started. The mean time to healing was 7.5 months (range: 5–10 months). Tibialization of fibula occurred in all patients as evident on radiographs. ConclusionsHuntington procedure is a simple and technically easy for large tibial defects. It does not require microsurgical skill and implants. The union of transferred fibula is faster than conventional graft as it is a vascularized graft. It is a rational choice for the treatment of large tibial defects in selected cases.

Extensor reconstruction of the knee using the fibular transposition technique after proximal tibial resection

BackgroundReconstruction of the extensor mechanism after resection of the proximal tibia is challenging, and several surgical procedures are available. The purpose of this study was to determine the outcome of the fibular transposition technique for reconstruction of the extensor mechanism of the knee after proximal tibial resection. MethodsWe retrospectively reviewed five consecutive patients who underwent resection of the proximal tibia with prosthetic reconstruction and reconstruction of the extensor using fibular transposition between 1997 and 2011. There were two female and three male patients with a mean age of 50years (range, 27 to 76years). A follow-up evaluation included both passive and active range of motion, extensor lag, the MSTS score and complications. ResultsPatients were followed up for 93months (range, 44 to 160months). The mean extensor lag and active flexion were four degrees (range, 0 to 10°) and 103° (range, 85 to 110°), respectively. The mean MSTS score was 80% (range, 73 to 90%). All patients were able to ambulate without crutches at the latest follow-up. ConclusionsThe utilization of the fibular transposition technique is a simple, reliable, and successful procedure for extensor reconstruction after proximal tibial resection.

The Huntington procedure: still a reasonable option for large tibial defects in paediatric patients.

BackgroundManagement of gap nonunion of tibia is technically difficult, time consuming, physically and psychologically demanding for the patient with unpredictable results. Various techniques have been described in literature for the treatment of gap nonunions, but each one has its own limitations.PurposeThis study reports the outcomes of ipsilateral fibular transposition for reconstruction of tibial defects in paediatric age group.MethodsWe retrospectively reviewed records of 14 patients who underwent surgery for gap nonunion tibia with ipsilateral tibialization of fibula. Fibula is transferred to tibia as pedicle graft in two-staged procedure. Due to retained blood supply to one end of the transplant, the graft easily takes up and hypertrophies upon weight bearing over a period of time.ResultsAverage time of radiographic union was 13.35 weeks. Guarded partial weight bearing was started at an average of 16.5 weeks with gradual progression to full weight bearing. The leg length discrepancy at final follow-up ranged from 0 to 7 cms with an average of 2.60 cms. Hypertrophy of tibialized fibula was observed in all patients, with 8 patients showed grafted fibula reaching the diameter of opposite tibia. On subjective assessment, 9 patients were highly satisfied, 4 patients were satisfied and one patient was dissatisfied with the procedure.ConclusionsHuntington procedure is a simple, cost-effective and easy procedure for large tibial defects in paediatric patients which does not require any specialized team and implants, and can be performed in moderately equipped hospital. Leg length discrepancy may be addressed, after the transferred fibula is well developed.

Reconstruction of Large Bone and Soft Tissue Defect Combined with Infection in the Lower Extremity with Free Flap Followed by Ipsilateral Vascularized Fibular Transposition

Reconstruction of Large Bone and Soft Tissue Defect Combined with Infection in the Lower Extremity with Free Flap Followed by Ipsilateral Vascularized Fibular Transposition

Reconstruction of composite tibial defect with free flaps and ipsilateral vascularized fibular transposition

Composite defects of the tibia following open fractures are among the most challenging of clinical problems. The aim of this study is to report the results of treatment using a free flap procedure followed by ipsilateral vascularized fibular transposition (IVFT) for reconstruction of composite tibial defects. Ten patients underwent a free flap procedure followed by IVFT and plating. The mean size of the flaps was 12.1 × 6 cm(2). The mean length of bone defect was 5.35 cm. IVFT were performed 4.3 months following the free flap. Patients were followed for an average of 3.4 years. All flaps survived. The average time to union of the proximal and distal ends was 5.2 and 6.7 months, respectively. There were neither stress fractures of the transferred fibula nor recurrent infections. One patient demonstrated a medial angulation of 8° in the reconstructed tibia but experienced no difficulties in activities of daily living. At the last follow-up time point, all patients were able to walk without an assist device and were satisfied with the preservation of the injured lower extremity. Free flap procedures followed by IVFT for the treatment of composite tibial defects may reduce complications at the recipient site and infections, such as osteomyelitis. The plating technique combined with IVFT allowed bone union without additional operations or stress fractures in our series. We suggest that staged free flap and IVFT is useful for the treatment of composite segmental tibial defects.

Functional results and quality of life after shoulder girdle resections in musculoskeletal tumors

From 1981 to 2001, 91 shoulder resections were performed to treat shoulder girdle tumors (64 primary and 27 metastatic) in 90 patients (53 male and 37 female patients). The mean age was 34 years in patients with a primary tumor and 61 years in those with metastases. There were 7 partial scapulectomies, 13 total scapulectomies, 56 proximal humeral resections, 5 diaphyseal resections, 5 total shoulder girdle resections (Tikhoff-Linberg procedure), and 5 other procedures performed. Prosthesis implantation was carried out in 41 cases, autologous fibular transposition was done in 19, and massive homologous bone grafting was done in 4. Of the patients, 37 were clinically reviewed with a mean follow-up of 4.7 years (range, 1-20 years) by use of the recommendations of the Musculoskeletal Tumor Society for pain, function, position of hand, lifting ability, manual dexterity, and satisfaction. Nine patients were reviewed via a questionnaire and telephone interview. Twenty-six had died, and eighteen were lost to follow-up. The best results were achieved after partial scapulectomy and after humeral resection reconstructed with fibular transposition, when the function of the rotator cuff was preserved. After total scapulectomy and after humeral resection with the implantation of a tumor endoprosthesis, the function of the shoulder remained moderate because the rotator cuff was damaged. The overall satisfaction was generally good after all types of shoulder resections as a result of pain relief, preserved hand function, and improvement of psychological status. Patients can compensate extremely well by using the preserved joints and the contralateral upper limb; therefore, patient satisfaction does not rely on shoulder function alone.

Ipsilateral fibular transposition in tibial nonunion using Huntington procedure: a 12-year follow-up study

Eleven patients (10 men and 1 woman) with a mean age of 32 years (range: 16–61 years) and a mean follow-up of 12 years (range: 2–21 years) were studied retrospectively after ipsilateral fibular transposition. The cause of tibial nonunion was a motor vehicle collision (MVC) in eight patients, a fall from a window in one, an adamantinoma in one, and osteomyelitis in one. There was one type I and eight type IIIb open fractures according to the Gustilo classification, and the nonunion was infected in seven patients. Healing of the tibial defect was obtained in eight patients, after a mean interval of 10.5 months. In the patient with the adamantinoma, resection of the tumour left a 22 cm defect in the tibia. Two patients required amputation for acute local infection. Seven of the eight patients in whom tibial union was achieved were able to walk with no aids. The authors conclude that transposition of the ipsilateral fibula is a valuable component of the therapeutic armamentarium and a salvage procedure for patients with multi-operated, infected or uninfected, tibial nonunion.

Treatment of Tibial Defect by Fibular Transposition using Ilizarov

Treatment of Tibial Defect by Fibular Transposition using Ilizarov

Tibial reconstruction by ipsilateral vascularized fibular transfer

Between 1979 and 1991 ipsilateral vascularized fibular transposition was performed on eight patients with segmental tibial defects following injury. We report these cases with a minimum follow-up of 2.5 years. All the tibial defects were the result of severe open fractures (Gustilo Grade III) and either bone loss or infected non-union, and ranged in size from 1 to 12 cm. The patients had an average of seven procedures and a delay of 33 months before fibular transfer. The procedure was successful in achieving fracture union in all cases, with an average time to union of 15 months (range, 5–33 months). Shortening of up to 3 cm and some residual ankle stiffness was found, but all patients were ambulating bearing full weight and six had returned to their previous occupation by their final follow-up. Only one patient had significant pain affecting function. This is a successful and relatively simple technique compared to microvascular and bone transport procedures for reconstructing segmental tibial defects with relatively avascular graft beds.

Treatment of Tibial Defects and Nonunions Using Ipsilateral Vascularized Fibular Transposition

Treatment of Tibial Defects and Nonunions Using Ipsilateral Vascularized Fibular Transposition

Comparison of Stifle Biomechanics after Two Different Techniques of Cranial Cruciate Ligament Repair

SummaryStifle joint biomechanics were evaluated by analysis of instant centre of motion, after cranial cruciate ligament transection and after stifle joint stabilization, using either the fibular head transposition or the under-and-over fascial strip technique. The instant centres of motion and resulting velocity vectors were determined by radiographic evaluation of the stifle of twelve fresh cadavers before and after cranial cruciate ligament transection, and after stabilization of the stifle joint by either the fibular head transposition or the under-and-over fascial strip technique. All 12 stifles had normal instant centres of motion before transection of the cranial cruciate ligament, and 10 of 12 were normal after transection. All six stifles repaired by fibular head transposition retained normal instant centre of motion. Abnormal instant centres of motion were present in three of six stifles repaired by the under-and-over technique. These differences were not statistically significant.Stifle joint biomechanics were evaluated by analysis of instant centre of motion after cranial cruciate ligament transection and after stifle joint stabilization using either the fibular head transposition or the underand-over fascial strip technique. Neither surgical technique consistently resulted in abnormal instant centres of motion.

Biomechanical Properties of the Stifle Joint Lateral Collateral Ligament in Dogs

Bone/lateral collateral ligament/bone preparations were tested and structural mechanical properties compared to properties of cranial cruciate ligament in 15 dogs. The lateral collateral ligament has sufficient stiffness to provide stifle joint stability and strength to resist acute overload following fibular head transposition.

Treatment of sequestra, pseudarthroses, and defects in the long bones of children who have chronic hematogenous osteomyelitis.

We reviewed the results, after follow-up ranging from twenty-three months to six years, in thirty-four patients who were treated during childhood for hematogenous osteomyelitis of a major long bone complicated by sequestration of a portion of the diaphysis and by pseudarthrosis or segmental bone loss, or both. Of the thirty-four lesions, twenty-four were in the tibia, eight were in the femur, and two were in the humerus. In twenty-three patients (Group I), the infection was still active, while in the other eleven (Group II), it was quiescent at the time of admission to the hospital. In nine of the patients in Group I (four tibial and five femoral lesions), an involucrum bridged the osseous defect, indicating that the periosteal tube had not been destroyed. In these nine patients, sequestrectomy and débridement, appropriate antibiotic therapy, and prolonged immobilization in a plaster cast resulted in healing of the defect without recurrence of the infection. In the remaining fourteen patients (twelve tibial and two femoral lesions), there was no periosteal new-bone formation, and operative treatment consisted of two stages: the first, to resolve the infection, and the second, to heal the osseous defect with corticocancellous iliac grafts. In the eleven patients in Group II (eight tibial, one femoral, and two humeral lesions), there were no involucra. All of these patients were treated with cancellous bone grafts and prolonged immobilization. In twenty-two of the thirty-four patients (thirteen in Group I and nine in Group II), there were varying degrees of angular deformity at the pseudarthrosis, necessitating correction by manipulation when the plaster cast was applied postoperatively (ten patients), by fibular transposition (six patients), or by fibular osteotomy in addition to manipulation (six patients). Excluding complications specific to the fibular transfer procedure, the complications in the Group-I patients (six recurrent postoperative infections, one fracture of the graft, and one non-union of a fibular strut graft) were approximately as frequent as those in the Group-II patients (one failure of fusion and two fractures of the graft). Operative treatment resulted in healing of all but one tibial lesion, in a patient who nonetheless had good function at follow-up. Of the seven limb-length discrepancies of 2.8 centimeters or more, by the latest follow-up two had been treated uneventfully: one by femoral and the other by tibial lengthening.(ABSTRACT TRUNCATED AT 400 WORDS)