Outcomes and complications of fibular head resection

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.

Fibulectomy for Primary Proximal Fibular Bone Tumors

“…En bloc resection for tumors at this site meets both primary aims and hence thist remains the most suitable surgical procedure. 22 23 …”

Tuberculous pseudotumor of fibular head

“…4 The incidence of CPN palsy after fibular head resection is not well established given the paucity of literature, with estimates ranging anywhere from 20-57%. 5,6 In a review of outcomes and complications of fibular head resection, grade 2 varus laxity was observed in 9 out of 14 patient. 6 In a retrospective study of 104 patients who had resection of fibula for various reasons, twenty six had resection of the proximal fibula for reconstruction of excised distal radius, however none of these patient had any demonstrable instability of the knee.…”

“…5,6 In a review of outcomes and complications of fibular head resection, grade 2 varus laxity was observed in 9 out of 14 patient. 6 In a retrospective study of 104 patients who had resection of fibula for various reasons, twenty six had resection of the proximal fibula for reconstruction of excised distal radius, however none of these patient had any demonstrable instability of the knee. 7 There was varus instability in 9 out of 19 patients who underwent fibular head resection for giant cell tumors in the distal end of radius despite attaching the tendons and ligaments detached from the fibular head to the proximal fibula with the drill holes.…”

Complications related to harvest of the proximal end of the fibula: A systematic review

“…In patients who undergo harvest of the fibular head, these soft tissue attachments can be preserved and reattached. The biceps femoris tendon and the lateral collateral ligament, in particular, can be attached to the lateral metaphysis of the tibia using a staple or anchor, with the knee in 20° of flexion . Other authors have repaired these attachments to capsular and ligamentous structures .…”