Progressive valgus deformity of the donor-site ankle after extraperiosteal harvesting the fibular shaft in children. Treatment with osteotomy and synostosis at one session

Veen, F J C van der; Strackee, Simon D.; Besselaar, P. P.

doi:10.1016/j.jor.2014.03.001

Cited by 3 publications

(2 citation statements)

References 20 publications

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“… 14 The donor site has a risk of ankle instability 15 and valgus deformity. 16 Second, bone transport has a high probability of needing bone grafting at the docking site. Therefore, surgery must be performed multiple times.…”

Section: Discussionmentioning

confidence: 99%

Efficacy of Temporary Intentional Leg Shortening and Deformation for Treatment of Massive Bone and Soft Tissue Defects in Three Patients

Tsuchiya¹,

Ugaji²,

Matsubara³

et al. 2022

Strategies in Trauma and Limb Reconstruction

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A bstract Aim This study describes the intentional deformation and shortening of a limb using external fixation (EF) in three patients with post-traumatic injury tibial defects and to assess the outcomes. Case description Three patients with infected non-unions and massive bone and soft tissue defects who were treated with temporary intentional leg shortening and deformation using a Taylor Spatial Frame (TSF) EF were retrospectively reviewed. The alignment was restored by gradual deformity correction and lengthening after a 2-week interval. No additional surgical intervention was required for soft tissue reconstruction after primary skin closure. Skin closure and good bone alignment were achieved in all patients. The functional outcomes and bone outcomes were evaluated for all cases according to the Paley criteria modified by the Association for the Study and Application of Methods of Ilizarov. All patients showed excellent bone outcomes. Two patients achieved excellent functional outcomes and one had a good outcome. The patient with a good outcome was unable to descend the stairs comfortably. Conclusion This technique is suitable for treating massive bone and soft tissue defects and should be considered as a treatment option. How to cite this article Ugaji S, Matsubara H, Aikawa T, et al . Efficacy of Temporary Intentional Leg Shortening and Deformation for Treatment of Massive Bone and Soft Tissue Defects in Three Patients. Strategies Trauma Limb Reconstr 2022;17(3):195–201.

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Section: Discussionmentioning

confidence: 99%

Efficacy of Temporary Intentional Leg Shortening and Deformation for Treatment of Massive Bone and Soft Tissue Defects in Three Patients

Tsuchiya¹,

Ugaji²,

Matsubara³

et al. 2022

Strategies in Trauma and Limb Reconstruction

View full text Add to dashboard Cite

show abstract

“…The fibula as a donor site may be questionable for a benign disease at early age. Many studies have given clear evidence that removal of a part of the fibula in childhood may lead to ankle problems in a large percentage of cases (Agarwal et al., 2017; Aldekhayel et al., 2016; Nathan et al., 2009; Omokawa et al., 1996; Sulaiman et al., 2015; Van der Veen et al., 2015). These problems include valgus ankle, ankle instability, hallux flexion weakness and hallux flexion contracture.…”

Section: Discussionmentioning

confidence: 99%

Vascularized second metatarsophalangeal joint transfer for radial deficiency – an update

Vilkki

Paavilainen

2018

J Hand Surg Eur Vol

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Vascularized second metatarsophalangeal joint transfer offers a possibility to reconstruct the radial support which is lacking in radial dysplasia. Our experience from 1987 to 2017 with 34 congenital radial club hand reconstructions have allowed a possibility for long-term evaluation of the method. Compared with conventional methods, second metatarsophalangeal joint transfer results in better wrist mobility and does not restrict typical ulnar growth. The balance of the wrist remains good until age 11. Thereafter, the growth of the vascularized bone graft transfer matches only partially the distal ulnar growth in adolescence, resulting in mild recurrence of radial deviation. A new option to create a two-bone forearm in selected Bayne-Klug Type III radial dysplasia cases will allow a relatively good pro-supination ability. Potentially, a proximal fibular epiphyseal transfer could be a future solution. Currently, a safe harvest of the proximal fibula at childhood remains controversial.

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Prevention of ankle joint deformities in children on the side of fibular graft intake for microsurgical transposition

Ryzhikov,

Vissarionov

2023

Pediatr Traum Orthop Reconstr Surg

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BACKGROUND: Reconstructive operations of the musculoskeletal system in children may require the removal of a massive autograft for microsurgical bone grafting. The traditional donor site is the diaphyseal part of the fibula. In the late postoperative period, these patients may develop complications such as a valgus deformity of the ankle joint on the side of the donor fibular defect. AIM: To analyze the effectiveness of surgical methods for the prevention of hallux valgus of the ankle joint after free transplantation of a fragment of the fibula to replace limb-bone defects in children. MATERIALS AND METHODS: The treatment results of 11 patients aged 11–16 years (6 girls and 5 boys), in whom an autograft from the fibular diaphysis was used to replace defects in long tubular bones were analyzed. Two patients had a femoral defect as a result of previously transferred hematogenous osteomyelitis. A congenital false joint of the femur was found in 2 patients, bones of the lower leg in 6, and the ulna in 1. The distal fragment of the resected fibula was stabilized by an autograft from the iliac bone, in eight and three cases at the level of the diaphysis and metaphysis of the specified fragment, respectively. The size of the resected fragment in % of the total length of the fibula and the level of distal osteotomy were considered. The presence and magnitude of the proximal displacement of the fragment and the position of the ankle joint gap were evaluated at least 5 years after surgery. RESULTS: In this study, ≥5 years after the intervention, proximal displacement of the distal fragment of the fibula was absent in only one patient. In the remaining 10, the displacement value did not exceed 3.5 mm. Valgus deformity in the ankle joint of 5° from the initial position developed in two patients. Its progression was prevented by temporary hemiepiphysis of the distal epiphysis of the tibia using a 4.0-mm diameter spongiose screw, whereas in up to 16 months, the valgus deformity progression stopped and decreased to initial values. CONCLUSIONS: Fibular resection in the optimal variant should preserve the distal part of the bone as much as possible, and the stability of the ankle joint increases with synostosis of the shin bones in the distal diaphyseal section without bringing the bones closer together. When a clinically significant valgus deformity appears (5° from the initial position) with the preservation of the function of the distal growth zone of the tibia, the use of temporary transphyseal hemiepiphysiodesis of the tibia for correction is optimal.

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Progressive valgus deformity of the donor-site ankle after extraperiosteal harvesting the fibular shaft in children. Treatment with osteotomy and synostosis at one session

Cited by 3 publications

References 20 publications

Efficacy of Temporary Intentional Leg Shortening and Deformation for Treatment of Massive Bone and Soft Tissue Defects in Three Patients

Efficacy of Temporary Intentional Leg Shortening and Deformation for Treatment of Massive Bone and Soft Tissue Defects in Three Patients

Vascularized second metatarsophalangeal joint transfer for radial deficiency – an update

Prevention of ankle joint deformities in children on the side of fibular graft intake for microsurgical transposition

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