Distal fibular excision: A review of the literature and presentation of our reconstruction technique case series

Lamb, Ashley; Mueller, Joseph D.; Levy, Ezra; Hobbs, Janet; Brien, Earl W.

doi:10.1016/j.ijscr.2021.01.105

Cited by 6 publications

(8 citation statements)

References 10 publications

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“…The literature proposed that ankle function can generally be preserved when there is a remnant of the distal fibula at least 20 mm above the distal tibiofibular joint. If this is not possible, reconstruction is required because distal fibula resection can cause ankle instability, valgus ankle deformity, and, eventually, secondary osteoarthritis [4][5][6]. However, distal fibula reconstruction in cases of bone and soft tissue tumours is an uncommon procedure, and currently, only case reports and case series have been described in the literature.…”

Section: Discussionmentioning

confidence: 99%

“…However, distal fibula reconstruction in cases of bone and soft tissue tumours is an uncommon procedure, and currently, only case reports and case series have been described in the literature. According to the literature, several techniques of distal fibula reconstruction have been reported, including vascularised autograft, nonvascularised autograft, allograft, soft tissue reconstruction, and ankle arthrodesis [4][5][6][7][8].…”

Section: Discussionmentioning

confidence: 99%

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Distal Tibiofibular Joint Reconstruction Using Autograft in a Rare Case of Lower Limb Sclerosing/Spindle Cell Rhabdomyosarcoma: A Two-Year Follow-Up

Othman¹,

Haflah²,

Sani³

et al. 2023

Cureus

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Sclerosing/spindle cell rhabdomyosarcoma (s-scRMS) is a rare variant of striated muscle tumours. It has been recognised as an individual entity, the fourth subtype of rhabdomyosarcoma in the latest WHO classification. In the paediatric population, it occurs more commonly in the paratesticular area, whereas in adults, it occurs more commonly in the head and neck region. It has distinctive characteristics in terms of its histopathological and immunochemistry findings, which help in accurate diagnosis. The mainstay of treatment is a multimodal approach, i.e., surgery, chemotherapy, and radiation therapy. However, no standard care is still being established internationally for adult cases. In adults, this tumour has a poorer prognosis as compared to children. We describe a patient with s-scRMS of the lower limb who has undergone wide local resection of the tumour with surgical reconstruction of the distal tibiofibular joint with autograft and its two-year outcome.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Distal Tibiofibular Joint Reconstruction Using Autograft in a Rare Case of Lower Limb Sclerosing/Spindle Cell Rhabdomyosarcoma: A Two-Year Follow-Up

Othman¹,

Haflah²,

Sani³

et al. 2023

Cureus

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“…Other authors have reconstructed the lateral collateral ligaments of the ankle to the tibia by suturing the distal ends of the peroneal tendons to the lateral tibia (Capanna et al, 1986; Papagelopoulos et al, 2005), or by using the peroneus brevis tendon (Lamb et al, 2021). Ligamentoplasty using the distal peroneal tendons may preserve ankle motion; however, it is not recommended in children because it does not avoid a valgus deformity when the medial tibial malleolus continues to grow.…”

Section: Discussionmentioning

confidence: 99%

“…Given the rarity of this tumor location (Niimi et al, 2008), the literature regarding this matter is scarce. Classical options described include ligamentoplasties to the lateral tibia using the distal peroneal or tibialis tendons (Capanna et al, 1986; Dieckmann et al, 2011; Durak et al, 1996; Lamb et al, 2021; Marcove & Rosen, 1980; Monson et al, 2014; Papagelopoulos et al, 2005; Shoji et al, 1970; Vaseenon et al, 2017; Yadav, 1981), tibiotalar arthrodesis (Dieckmann et al, 2011; Ozaki et al, 1997; Papagelopoulos et al, 2005; Perisano et al, 2012; Saadon et al, 2017; Wang et al, 2020; Yin et al, 2015; Yoshida et al, 2017), fixation of the proximal fibula to the tibia (CARRELL, 1938; Persson & Rydholm, 1979), prosthethic ankle joint replacement (Papagelopoulos et al, 2005; Perisano et al, 2012), reconstruction with distal fibular allografts (Jamshidi et al, 2013; Lubliner et al, 1985; Papagelopoulos et al, 2005; Perisano et al, 2012; Saadon et al, 2017; San‐Julian et al, 2008; Wang et al, 2020), contralateral fibular autografts (Wang et al, 2020), iliac crest bone grafts (Eger et al, 2004; Papagelopoulos et al, 2005; Perisano et al, 2012), rotating the ipsilateral proximal fibula 180° (Capanna et al, 1986; Dieckmann et al, 2011; Papagelopoulos et al, 2005; Perisano et al, 2012; Saadon et al, 2017; Wang et al, 2020), and pedicled or free fibular flaps (Bibbo et al, 2015; Cavadas & Thione, 2015; de Gauzy et al, 2002; Gao et al, 2016; Panuel et al, 1997; Papagelopoulos et al, 2005; Rajacic & Dashti, 1996). Furthermore, there are case series in young patients in which no ankle reconstruction was performed, wit...…”

Section: Introductionmentioning

confidence: 99%

Ankle joint salvage surgery with an ipsilateral mid‐fibula osteocutaneous free flap and contralateral anterolateral thigh free flap: A case report and literature review

et al. 2022

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The tibiofibular joint can be reconstructed after distal fibular sarcoma salvage surgery to maintain ankle stability and achieve early gait. Classical reconstructive options include ligamentoplasties, arthrodesis, prosthetic replacement, bone grafts, and pedicled ipsilateral or free contralateral fibular bone flaps. We present a novel strategy for reconstruction of the ankle in an elderly patient and a literature review. A 68-year-old man presented with a high-grade myxofibrosarcoma to his distal fibula.Wide resection of the tumor and adjacent structures left a 12 Â 12 Â 8 cm defect including the distal fibula (10 cm), a 2 cm fragment of the lateral cortex of the tibia, the lateral anterior and superficial posterior compartments, and the lateral compartment. A 3 cm distal fibula remnant was left in the ankle mortice. Reconstruction was performed using a free ipsilateral 13-cm diaphyseal osteocutaneous fibular flap telescoped into the distal fibula remnant and anastomosed to the anterior tibial artery. A pre-bent L-shaped locking plate was used to reconstruct a syndesmotic joint. A 21 Â 13 cm suprafascial ALT flap was anastomosed to the proximal stump of the peroneal artery to cover the soft tissue defect. The patient had no complications and was ambulating with full weight bearing by postoperative week 11. He received postoperative chemo and radiotherapy. Three years postoperatively, he is tumor free, has complete ankle ROM and stability, and ambulates with no restrictions. Limb sparing surgery with a functional tibiofibular joint reconstruction should be considered to attain an early functional recovery after distal fibula sarcomas resection.

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“…All these methods have different advantages and disadvantages. In distal fibular resections without reconstruction, the loss of the stabilizing effect of the lateral malleolus is a challenge to be overcome [ 5 , 15 ]. The soft tissue reinforcement will not fully compensate and the ankle may be destabilized in valgus [ 5 ].…”

Section: Introductionmentioning

confidence: 99%

Distal Fibula Reconstruction in Primary Malignant Tumours

et al. 2021

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(1) Background: Restoration of ankle biomechanics after distal fibula (DF) resection in bone sarcomas can be performed with different techniques. We report the functional and oncological outcomes of a case series; (2) Methods: Ten patients (5 females and 5 males) with a mean age of 27 years (range 10–71) were retrospectively evaluated. Following the resection, different techniques were used to reconstruct the ankle: tibiotalar arthrodesis, residual lateral malleolus fixed to the tibia, non-vascularized or rotational vascularized fibula transposition and intercalary allograft. All complications were recorded, and the functional outcomes were evaluated; (3) Results: The mean follow-up time was 54 months (range, 13–116). Six patients were free of disease while four patients died of disease. All patients had a stable ankle and bone union, which was achieved after a mean of 9.4 months (range 3–20). The mean MSTS Score was 26.7 (range 21–30). Chronic ankle pain and peroneal external nerve palsy were observed. Patients underwent additional surgeries for deep infection and for equinus ankle deformity. No local recurrence was observed. Metastasis occurred in four patients after a mean of 14.7 months (range 2–34); (4) Conclusions: After DF resection, the restoration of ankle biomechanics gives acceptable functional results, but a larger series of patients with long-time follow-up are required to confirm the durability of the reconstruction.

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Distal fibular excision: A review of the literature and presentation of our reconstruction technique case series

Cited by 6 publications

References 10 publications

Distal Tibiofibular Joint Reconstruction Using Autograft in a Rare Case of Lower Limb Sclerosing/Spindle Cell Rhabdomyosarcoma: A Two-Year Follow-Up

Distal Tibiofibular Joint Reconstruction Using Autograft in a Rare Case of Lower Limb Sclerosing/Spindle Cell Rhabdomyosarcoma: A Two-Year Follow-Up

Ankle joint salvage surgery with an ipsilateral mid‐fibula osteocutaneous free flap and contralateral anterolateral thigh free flap: A case report and literature review

Distal Fibula Reconstruction in Primary Malignant Tumours

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