Strategies in Trauma and Limb Reconstruction

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VOLUME 7 , ISSUE 1 ( April, 2012 ) > List of Articles

Original Article

Outcomes and complications of fibular head resection

D. K. Agarwal, S. Saseendar, D. K. Patro, J. Menon

Keywords : Fibula, Bone transplantation, Morbidity, Joint laxity, Fibular regeneration

Citation Information : Agarwal DK, Saseendar S, Patro DK, Menon J. Outcomes and complications of fibular head resection. 2012; 7 (1):27-32.

DOI: 10.1007/s11751-012-0133-8

License: CC BY-NC-SA 4.0

Published Online: 01-12-2012

Copyright Statement:  Copyright © 2012; The Author(s).


Abstract

The fibular head is often used as donor graft material for reconstruction of defects of the distal radius. However little is known on the safety of such a procedure. This report describes the long-term donor-site morbidity following the procedure. Fourteen patients who underwent simple or marginal resections of the proximal fibula between 1990 and 2007 were reviewed. Subjective donor-site morbidity, knee and ankle range of motion and instability, presence of sensory or motor function loss, gait and fibular regeneration were assessed. The mean age at surgery was 25 years; six were male, eight were female and the mean follow-up was 11 years. Abnormal clinical findings were present in 10 patients (71.4 %): nine patients (64.3 %) had Grade 2 varus laxity at the knee confirmed by stress radiographs; one had sensory loss in the distribution of the superficial peroneal nerve. Patients with varus laxity had significantly higher mean age at surgery than those without varus laxity (p = 0.001). None had deformity at the knee or ankle. The range of joint movements was normal. All had a normal tibiotalar angle and none had proximal migration of the fibula. One patient demonstrated near-complete regeneration of the fibula. Donor-site morbidity following simple and marginal resection of the proximal fibula is acceptable. Older patients had a higher risk of demonstrable varus laxity at the knee but proximal fibula resection in children appears to be safe.


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  1. Springfield D (1996) Autograft reconstructions. Orthop Clin North Am 27:483-492
  2. Weiland AJ, Moore JR, Daniel RK (1983) Vascularized bone autografts. Clin Orthop 174:87-95
  3. Murray RA, Brindley HH (1957) The proximal fibula: indications for excision and use. South Med J 50(3):297-302
  4. Murray JA, Schlafly B (1986) Giant cell tumors in the distal end of the radius. Treatment by resection and fibular autograft interpositional arthroplasties. J Bone Joint Surg Am 68:687-694
  5. Bassiony AA (2009) Giant cell tumour of the distal radius: wide resection and reconstruction by non-vascularised proximal fibular autograft. Ann Acad Med Singap 38(10):900-904
  6. Anderson AF, Green NE (1991) Residual functional deficit after partial fibulectomy for bone grafts. Clin Orthop 267:137-140
  7. Draganich LF, Nicholas RW, Shuster JK et al (1991) The effects of resection of the proximal part of the fibula on stability of knee and on gait. J Bone Joint Surg (Am) 73:575-583
  8. Bickels J, Kollender Y, Pritsch T, Meller I, Malawer MM (2006) Knee stability after resection of the proximal fibula. Clin Orthop 454:198-201
  9. Dieckmann R, Gebert C, Streitbürger A, Henrichs MP, Dirksen U, Rödl R, Gosheger G, Hardes J (2011) Proximal fibula resection in the treatment of bone tumours. Int Orthop 35(11):1689- 1694
  10. Rettig A (1991) Medial and lateral ligament injuries. In: Scott W (ed) Ligament and extensor mechanism injuries of the knee: diagnosis and treatment. Mosby, St Louis
  11. Herranz PG, Rio AD, Burgos J, Mondejar JAL, Rapariaz JM (2003) Valgus deformity after fibular resection in children. J Pediatr Orthop 23:55-59
  12. Park HW, Kim HW, Kwak YH, Roh JY, Lee JJ, Lee KS (2011) Ankle valgus deformity secondary to proximal migration of the fibula in tibial lengthening with use of the Ilizarov external fixator. J Bone Joint Surg Am 93:294-302
  13. Wang Q, Whittle M, Cunningham J, Kenwright J (1996) Fibula and its ligaments in load transmission and ankle joint stability. Clin Orthop 330:261-270
  14. Lambert KL (1971) The weight bearing function of the fibula. A strain gauge study. J Bone Joint Surg 53-A:507-513
  15. Takebe K, Nakagawa A, Minami H, Kanazawa H, Hirohata K (1984) Role of the fibula in weight-bearing. Clin Orthop 184:289-292
  16. Goh JC, Mech AM, Lee EH, Ang EJ, Bayon P, Pho RW (1992) Biomechanical study on the load-bearing characteristics of the fibula and the effects of fibular resection. Clin Orthop Relat Res 279:223-228
  17. Grood ES, Noyes FR, Butler DL, Suntay WJ (1981) Ligamentous and capsular restraints preventing straight medial and lateral laxity in intact human cadaver knees. J Bone Joint Surg 63-A:1257-1269
  18. Youdas JW, Wood MB, Cahalan TD et al (1988) A quantitative analysis of donor site morbidity after vascularised fibular transfer. J Orthop Res 6:621-629
  19. Uchiyama E, Suzuki D, Kura H, Yamashita T, Murakami G (2006) Distal fibular length needed for ankle instability. Foot Ankle Int 27(3):185-189
  20. Babhulkar SS, Pande KC, Babhulkar S (1995) Ankle instability after fibular resection. J Bone Joint Surg Br 77:258-261
  21. Pho RW (1981) Malignant giant-cell tumor of the distal end of the radius treated by a free vascularized fibula transplant. J Bone Joint Surg Am 63:877-884
  22. Bird HA, Tribe CR, Bacon PA (1978) Joint hypermobility leading to osteoarthrosis and chondrocalcinosis. Ann Rheum Dis 37:203-211
  23. Kannus P (1988) Long-term results of conservatively treated medial collateral ligament injuries of the knee joint. Clin Orthop 226:103-112
  24. Kannus P (1989) Nonoperative treatment of grade II and III sprains of the lateral ligament compartment of the knee. Am J Sports Med 17:83-88
  25. Gore DR, Gardner GM, Sepic SB et al (1987) Function following partial fibulectomy. Clin Orthop 220:206-210
  26. Bettin D, Böhm H, Clatworthy M, Zurakowski D, Link TM (2003) Regeneration of the donor side after autogenous fibula transplantation in 53 patients. Acta Orthopaedica 74(3):332-336
  27. Lee EH, Goh JCH, Helm R et al (1990) Donor site morbidity following resection of the fibula. J Bone Joint Surg 72B:129-131
  28. Bodde EW, Visser ED, Duysens JEJ, Harman EHM (2003) Donor site morbidity after free vascularized fibular transfer; subjective and quantitative analysis. Plast Reconstr Surg 11:2237-2242
  29. Edelman R, Barbacci D (1992) Fibular regeneration. J Foot Surg 31(49):368-371
  30. Vandeweyer E, Gebhart M (1996) Complete fibular regeneration following removal of the fibula for bone grafting. Acta Chir Belg 96(4):182-184
  31. Hsu LC, Yau AC, O'Brien JP et al (1972) Valgus deformity of the ankle resulting from fibular resection for a graft in subtalar fusion in children. J Bone Joint Surg (Am) 54:585-594
  32. Wiltse LL (1972) Valgus deformity of the ankle: a sequel to acquired or congenital abnormalities of the fibula. J Bone Joint Surg (Am) 54:595-606
  33. Kanaya K, Wada T, Kura H, Yamashita T, Usui M, Ishii S (2002) Valgus deformity of the ankle following harvesting of a vascularized fibular graft in children. J Reconstr Microsurg 18(2):91-96
  34. Fragniere B, Wicart P, Mascard E, Dubousset J (2003) Prevention of ankle valgus after vascularized fibular grafts in children. Clin Orthop 408:245-251
  35. Pacelli LL, Gillard J, McLoughlin SW, Buehler MJ (2003) Biomechanical analysis of donor-site ankle instability following free fibular graft harvest. J Bone Joint Surg (Am) 85-A(4):597-603
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