Strategies in Trauma and Limb Reconstruction

Register      Login

VOLUME 16 , ISSUE 2 ( May-August, 2021 ) > List of Articles

CASE REPORT

Regeneration of Fibula Following Distal Fibulectomy for Ankle Arthrodesis Following the Use of Calcium Sulphate Granules: A Case Series and Review of the Literature

Poornanand Goru, Syed Haque, Tim Hirst, Gopalkrishna G Verma, Abubakar Mustafa, Amer Shoaib

Keywords : Calcium sulphate, Fibulectomy, Regeneration

Citation Information : Goru P, Haque S, Hirst T, Verma GG, Mustafa A, Shoaib A. Regeneration of Fibula Following Distal Fibulectomy for Ankle Arthrodesis Following the Use of Calcium Sulphate Granules: A Case Series and Review of the Literature. 2021; 16 (2):123-126.

DOI: 10.5005/jp-journals-10080-1531

License: CC BY-NC-SA 4.0

Published Online: 27-10-2021

Copyright Statement:  Copyright © 2021; The Author(s).


Abstract

Regeneration of the fibula following partial fibulectomy is a common and well-reported phenomenon in children. However, there is limited literature on the regeneration of fibula in skeletally mature individuals. We report a case series of regeneration of the distal fibula following partial distal fibulectomy. In both these cases, calcium sulphate (Stimulan—Biocomposites, Keele, UK) antibiotic-loaded beads were used for local delivery of a high concentration of antibiotics. However, calcium sulphate worked as an osteoconductive agent and led to regeneration of the fibula. Regeneration of the fibula has its benefits and downside. Regeneration can be beneficial in patients in whom future arthroplasty is considered as total ankle replacement would not be possible in the absence of distal fibula. On the contrary, a regenerated fibula can be a source of ankle pain related to the syndesmotic joint. There is also a report of infection recurring in the regenerated fibula. Hence, while using calcium sulphate beads either as a spacer or as a vehicle for local delivery of antibiotics, the operating surgeon needs to be aware of the risk of regeneration of the fibula if the periosteum is preserved.


HTML PDF Share
  1. Yang L, Xu HZ, Liang DZ, et al. Biomechanical analysis of the impact of fibular osteotomies at tibiotalar joint: a cadaveric study. Indian J Orthop 2012;46(5):520–524. DOI: 10.4103/0019-5413.101043. PMCID: PMC3491784.
  2. Xin ZF, Kim KH, Jung ST. Regeneration of the fibula using a periosteum-preserving technique in children. Orthopedics 2009;32(11):820. DOI: 10.3928/01477447-20090922-14.
  3. Bettin D, Böhm H, Clatworthy M, et al. Regeneration of the donor side after autogenous fibula transplantation in 53 patients: evaluation by dual x-ray absorptiometry. Acta Orthop Scand 2003;74(3):332–336. DOI: 10.1080/00016470310014274.
  4. Edelman R, Barbacci D. Fibular regeneration. J Foot Surg 1992;31(4):368–371. PMID: 1401738.
  5. Springfield D. Autograft reconstructions. Orthop Clin North Am 1996;27(3):483–492. PMID: 8649731.
  6. Weiland AJ, Moore JR, Daniel RK. Vascularized bone autografts. Clin Orthop 1983;174:87–95. PMID: 6339145.
  7. González-Herranz P, del Río A, Burgos J, et al. Valgus deformity after fibular resection in children. J Pediatr Orthop 2003;23(1):55–59. PMID: 12499944.
  8. Strocchi R, Orsini G, Iezzi G, et al. Bone regeneration with calcium sulfate: evidence for increased angiogenesis in rabbits. J Oral Implantol 2002;28(6):273–278. DOI: 10.1563/1548-1336(2002)028<0273:BRWCSE>2.3.CO;2.
  9. Yashavantha Kumar C, Nalini KB, Menon J, et al. Calcium sulfate as bone graft substitute in the treatment of osseous bone defects, a prospective study. J Clin Diagn Res 2013;7(12):2926–2928. DOI: 10.7860/JCDR/2013/6404.3791.
  10. Kelly CM, Wilkins RM, Gitelis S, et al. The use of a surgical grade calcium sulfate as a bone graft substitute: results of a multicenter trial. Clin Orthop Relat Res 2001;(382):42–50. DOI: 10.1097/00003086-200101000-00008.
  11. Gitelis S, Piasecki P, Turner T, et al. Use of a calcium sulfate-based bone graft substitute for benign bone lesions. Orthopedics 2001;24(2): 162–166. PMID: 11284599.
  12. Borrelli J Jr, Prickett WD, Ricci WM. Treatment of nonunions and osseous defects with bone graft and calcium sulfate. Clin Orthop Relat Res 2003;(411):245–254. DOI: 10.1097/01.blo.0000069893.31220.6f.
  13. Smith JT, Chiodo CP, Singh SK, et al. Open ankle arthrodesis with a fibular-sparing technique. Foot Ankle Int 2013;34(4):557–562. DOI: 10.1177/1071100713477617.
  14. Al-Maiyah M, Hemmady MV, Shoaib A, et al. Recurrence of chronic osteomyelitis in a regenerated fibula after 65 years. Orthopedics 2007;30(5):403–404. DOI: 10.3928/01477447-20070501-12.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.