Reconstruction of distal fibula with osteoarticular allograft after tumor resection

Jamshidi, Khodamorad; Mazhar, Farid Najd; Masdari, Zahra

doi:10.1016/j.fas.2012.09.001

Cited by 23 publications

(24 citation statements)

References 7 publications

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“…7 Local surgery of tumors of the distal fibula presents two problems: the adequacy of the resection and the reconstruction of the ankle. 8 The treatment mode of choice for GCT is surgical resection. Most GCT cases are benign and are predilected in the proximity of joints.…”

Section: Discussionmentioning

confidence: 99%

“…The cartilaginous facet of the proximal fibula will then articulate with the talus, and the styloid apophysis will become the apex of the neo malleolus, rendering stability to the ankle. 8 Rehabilitative physiotherapy is needed to improve the grade of range of motion of the joint and weight-bearing ability. Informed consent is a procedure that should be done to help the patient understanding the aim of every proceeding.…”

Section: Discussionmentioning

confidence: 99%

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Proximal Fibular Autograft Reconstruction After Resection GCT Distal Fibula

Idulhaq

Azizi

2021

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Background: Giant cell tumor (GCT) is a destructive bone tumor. The predilection of the GCT is mostly on the epiphysial of long bones. GCT of the distal fibula is a very rare case that becomes challenging in surgical management. The chosen surgical management is crucial and still under debate.Case Report: A 38-years-old male complaint of a painful lump in the lateral side of his left ankle for three months. Plain radiographs demonstrate a lytic lesion involving distal fibula, appropriate with 2nd-grade Campanacci. MRI showed a mass centered on the distal fibula with intermediate to high T2 signal, low T1 signal, and homogenous contrast enhancement. The patient underwent a wide excision and reconstruction of the distal fibula with a fibular head graft from the ipsilateral side. After fifteen months of evaluation, the result was excellent. The patient can full-wight-bearing with a full range of ankle joint movement, return to daily activities without pain, and no signs of recurrence. Functional status measured by the MSTS and CAIT showed good results, with total scores was 28 and 27.Discussion: Ten centimeters distal fibula is a crucial component to form stability of the ankle. Reconstruction of the distal fibula after wide excision requires the bone graft and is considered to maintain ankle stability. It can be achieved using autograft from fibula or iliac crest.Conclusion: Reconstruction of distal fibula GCT with proximal fibular autograft showed a great result. This method is a viable option as it provides good pain relief and functional improvement.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Proximal Fibular Autograft Reconstruction After Resection GCT Distal Fibula

Idulhaq

Azizi

2021

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“…Finally, Jamshidi et al [10] reconstructed a distal fibula using a cryopreserved distal fibular allograft in 4 patients showing malignant tumors, resulting in complete articular motions and stability of the ankle. There was one case of postoperative infection.…”

Section: Discussionmentioning

confidence: 99%

Distal Fibular Reconstruction Using Iliac Grafting and Emslie-Vidal’s Ligamentoplasty after Exeresis of Single Renal Carcinoma Metastasis

Maury

Granier

Sleth

et al. 2020

Case Reports in Orthopedics

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Introduction. Restoring lateral ankle stability following distal resection of the fibula is a difficult procedure for which several surgical techniques have been proposed. Each of these techniques has potential drawbacks. This report presents a new option for fibular reconstruction. Case Study. We report the case of a 68-year-old male with evolving pain in the left ankle throughout the past 3 months. Three years prior to consultation, he underwent left nephrectomy for clear-cell adenocarcinoma. A swelling on the external side of the left ankle was noticed upon clinical examination, with no signs of inflammation. The ankle was stable with normal mobility. Radiographic examination revealed a 4 cm lytic lesion on the lateral malleolus with internal and external cortical damages as well as invasion of the soft tissues. Neither lower peroneotibial nor tibiotarsial joints were invaded. Needle biopsy confirmed the presence of metastatic renal clear-cell adenocarcinoma. Consequently, large exeresis of this single metastasis was indicated while preserving functional integrity of the ankle. Following block resection of the distal fibula including the lower tibioperoneal joint, a bicortical autograft was positioned to abut against the external side of the talus. Emslie-Vidal’s ligamentoplasty procedure was performed with half of the short peroneal passed under the pedal flexor, then in the bone abutment, and finally through a calcaneal bone tunnel. Peroneus muscles were stabilized using a fragment sampled from the Achilles tendon. Pain decreased in 3 months, and the ankle was stable with normal functionality at a 5-year follow-up. Discussion. Reconstruction of the lateral ankle following fibular resection is possible by reconstructing the external facet of the malleolus using an autograft associated with Emslie-Vidal’s ligamentoplasty procedure, hence stabilizing both tibiotalar and subtalar joints. This surgical procedure allowed the patient to return to his daily activities with neither instability nor evolution towards short-term tibiotalar arthrosis.

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“…Reconstruction of the lateral malleolus defect is generally recommended when the defect is causing valgus instability of the ankle joint. 1,2,4–7 The current methods used to repair a lateral malleolus defect include a pedicled vascularized fibular head graft, 4 iliac crest graft, 5 bone flap from the lateral eminence of the scapula, 6 and allograft bone transplantation. 7 However, there is no gold standard for lateral malleolus defect repair.…”

Section: Discussionmentioning

confidence: 99%

Repair of a lateral malleolus defect with a composite pedicled second metatarsal flap

et al. 2018

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The patient was a 26-year-old man who fell while riding a motorcycle and friction led to defects in the lateral malleolus and soft tissue of the ankle. Although the wound surface healed with scarring and skin grafting, the patient had symptoms of ankle joint instability 4 months after the injury. Using a second metatarsal composite tissue flap with a dorsalis pedis artery pedicle, we repaired the soft tissue defect of the ankle and reconstructed the lateral malleolus. The head of the metatarsal bone was used to reconstruct the lateral malleolus and the flap was used to cover the wound surface. The distal fibula and metatarsus were completely healed 36 months postoperatively. The ankle had maintained stability at this time, with equal limb length and only a mild limitation of dorsal flexion in the ankle joint. The patient could walk, jog, and walk up and down stairs without limitations. There was no pain or limitation in activity at the donor site. Our findings suggest that the second metatarsal composite tissue flap with a dorsalis pedis artery pedicle is an effective option in reconstruction of the adult distal fibula.

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Reconstruction of distal fibula with osteoarticular allograft after tumor resection

Cited by 23 publications

References 7 publications

Proximal Fibular Autograft Reconstruction After Resection GCT Distal Fibula

Proximal Fibular Autograft Reconstruction After Resection GCT Distal Fibula

Distal Fibular Reconstruction Using Iliac Grafting and Emslie-Vidal’s Ligamentoplasty after Exeresis of Single Renal Carcinoma Metastasis

Repair of a lateral malleolus defect with a composite pedicled second metatarsal flap

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