Replacement of the Lateral Malleolus of the Ankle Joint with a Reversed Proximal Fibular Bone Graft

Herring, Charles L.; Hall, Reginald L.; Goldner, J. Leonard

doi:10.1177/107110079701800601

Cited by 22 publications

(19 citation statements)

References 15 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Preferred techniques for reconstruction of isolated defects of the distal fibula are: fibular segment transfer from the contralateral side, proximal-pro-distal inversion substitution of the ipsilateral fibula [25], rib, scapular and iliac crest grafting, and cancellous bone grafting. Segment transport with an external fixator alone is possible for the fibula, but is complex and prolonged [26,27].…”

Section: Discussionmentioning

confidence: 99%

Defect Fracture of the Distal Fibula with Soft Tissue Damage (Gustilo IIIB) in an Adolescent

Lattig¹,

Remiger²,

Blatter³

et al. 2002

European Journal of Trauma

View full text Add to dashboard Cite

Open fractures of the lower limb are often combined with soft tissue defects and require a musculocutaneous flap in addition to bony reconstruction. We report the treatment and progress of a third-degree open fracture of the lower limb with a defect of the distal fibula and a Salter III fracture of the medial malleolus in a 15-year-old patient. The defect was reconstructed with a rib-latissimus dorsi flap and stabilized with a new type of internal fixator (PointContact Fixator®, Synthes Ltd).

show abstract

Section: Discussionmentioning

confidence: 99%

Defect Fracture of the Distal Fibula with Soft Tissue Damage (Gustilo IIIB) in an Adolescent

Lattig¹,

Remiger²,

Blatter³

et al. 2002

European Journal of Trauma

View full text Add to dashboard Cite

show abstract

“…For this reason, reconstruction is necessary after resection of the distal fibula. Reconstruction with a fibula head autograft or allograft fibula as advocated by some authors [4,6,12] risks the added complication of delayed union or nonunion, periprosthetic fracture, destabilization of the proximal tibiofibular joint, and wound and hardware complications, which can increase if adjuvant radiation is required. Dieckmann et al [7] presented a series of 11 patients who underwent distal fibula resection for tumors with subsequent hindfoot arthrodesis using a retrograde nail.…”

Section: Discussionmentioning

confidence: 99%

“…It thus prompted us to explore the plausibility of a peroneus brevis tenodesis directly to the lateral distal tibia as described in this article. Because of the relative rarity of distal fibula tumors, surgeons disagree about the best way to manage the ankle after distal fibulectomy [1,7,9,12]. Options available for the treating surgeon include: resection of the distal fibula without reconstruction of the lateral ankle, especially if there is no lateral talar subluxation [3,19,20], repairing the residual lateral ankle ligaments to the distal tibia [8,26], reconstruction of the lateral ankle using the patient's fibula head mobilized distally [4,6,12], use of a fibula allograft or iliac crest graft to reconstruct the ankle [9,17], or tibiotalar arthrodesis with or without inclusion of the subtalar joint [7].…”

Section: Discussionmentioning

confidence: 99%

“…Because of the relative rarity of distal fibula tumors, surgeons disagree about the best way to manage the ankle after distal fibulectomy [1,7,9,12]. Options available for the treating surgeon include: resection of the distal fibula without reconstruction of the lateral ankle, especially if there is no lateral talar subluxation [3,19,20], repairing the residual lateral ankle ligaments to the distal tibia [8,26], reconstruction of the lateral ankle using the patient's fibula head mobilized distally [4,6,12], use of a fibula allograft or iliac crest graft to reconstruct the ankle [9,17], or tibiotalar arthrodesis with or without inclusion of the subtalar joint [7]. The potential complications of these techniques include loss of motion in the ankle and subtalar joints, nonunion or delayed union at arthrodesis sites, periprosthetic fractures, further destabilization of the proximal tibiofibular joint, nerve injuries, and wound and hardware complications, which can increase if radiation or chemotherapy is required [2,3,6,7,13,23].…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Lateral Ankle Stabilization After Distal Fibular Resection Using a Novel Approach: A Surgical Technique

Monson

Vojdani

Dean

et al. 2014

Clinical Orthopaedics &Amp; Related Research

View full text Add to dashboard Cite

Background After tumor resection involving the distal fibula, the method for recreating stability of the lateral ankle remains controversial. Many reconstructive options exist, including allograft reconstruction and arthrodesis; however, each of these approaches has significant potential disadvantages. Description of Technique The distal fibula is resected as necessary to obtain negative margins for local control of the neoplasm. Reconstruction of the lateral ankle ligamentous complex is performed using the peroneus brevis tendon to reestablish lateral and anterior stability of the tibiotalar joint. The peroneus brevis tendon is transected proximally at it myotendinous junction and then sutured to the calcaneofibular and anterior talofibular ligaments in sequence and then tenodesed to the lateral distal tibia with suture anchors and a staple. Methods We present three patients who underwent distal fibulectomy for tumors originating in the distal fibula. All patients who have undergone the reconstruction being described are included within this cohort study. The patients were assessed clinically and radiographically at a range of 14 months to 9.5 years (average, 4.8 years) for functional recovery, return of range of motion, stability of the ankle, and imaging evidence of arthrosis and instability. Results There were no episodes of instability or early progression to arthrosis. In addition, all patients obtained excellent ankle stability and range of motion on examination, but two had complications. One sustained a traumatic fracture to the base of the fifth metatarsal that healed with nonsurgical treatment and another who underwent further fibular shortening and bursectomy at the tip of the residual fibula with complete relief of his symptoms. Conclusions Reconstruction of the lateral ankle after distal fibular resection is possible using the peroneus brevis tenodesed to the distal tibia and sutured to the remnants of the calcaneofibular and anterior talofibular ligaments as described in this surgical technique. In this small group, we found that patients were able to return to normal daily activities without instability or progression to tibiotalar arthrosis at short term; however, longer followup and larger series of patients are called for to confirm these findings.

show abstract

“…In such instances, ankle stability is obtained via either soft tissue and ligament reconstruction or tibiatalar arthrodesis [20] 1 [16,23,36]. In other cases, fibular resection is followed by reconstruction with allograft, autografts, pedicled vascularised epiphyseal transfers using the ipsilateral proximal fibula or a long bone graft from the iliac crest, bone transplants, or prosthetic ankle joint replacement [3,11,13,24,[37][38][39][40]. At present, however, the choice of a specific procedure is frequently based on the surgeon's preference and experience, rather than being dictated by the nature and extension of the disease, reflecting the lack of guidelines and high-quality, large-scale studies on the subject.…”

Section: Surgical Techniques For Distal Fibular Tumoursmentioning

confidence: 99%

Clinical management and surgical treatment of distal fibular tumours: a case series and review of the literature

Perisano

Marzetti

Spinelli

et al. 2012

International Orthopaedics (SICOT)

View full text Add to dashboard Cite

Purpose Study reports clinical and functional outcomes of surgical treatment in a case series of nine patients with distal fibular tumours. Methods Nine patients with distal fibular tumours were observed between 2005 and 2010. A PubMed search was performed using the terms "fibula", "lower limb tumour [cancer]", "sarcoma", "Ewing", "peroneal", "fibular metastasis", and "limb-salvage surgery". Results In all our patients, lesions were unilateral. All patients complained of pain; limping was present in 5 of 9 tumours. Patients were managed surgically, except one who underwent local radiotherapy. In six patients, a benign or tumor-like lesion was detected. Malignancies consisted of metastatic lung adenocarcinoma (two cases) or multifocal mesenchymal cancer (one case). Non-malignant lesions were treated by curettage and filling, followed by internal fixation when needed. In malignant or locally aggressive lesions, metadiaphyseal fibular resection was performed. The literature search retrieved either case reports or small case series, reflecting the rarity of distal fibular tumours. Surgical treatment was successful in all patients with benign lesions, whereas the rate of success was 40-100 % in case of malignancies. Conclusions Given the low incidence of distal fibular tumours, controversies exist about the optimal surgical management. Clinical observation and imaging should be reserved to asymptomatic benign lesions. In non-malignant tumours causing pain, limping, and pathological fractures; in malignancies, surgery is recommended. Finally, in patients with asymptomatic lesions of uncertain nature, biopsy and histological examination should be performed to plan appropriate management.

show abstract

Replacement of the Lateral Malleolus of the Ankle Joint with a Reversed Proximal Fibular Bone Graft

Cited by 22 publications

References 15 publications

Defect Fracture of the Distal Fibula with Soft Tissue Damage (Gustilo IIIB) in an Adolescent

Defect Fracture of the Distal Fibula with Soft Tissue Damage (Gustilo IIIB) in an Adolescent

Lateral Ankle Stabilization After Distal Fibular Resection Using a Novel Approach: A Surgical Technique

Clinical management and surgical treatment of distal fibular tumours: a case series and review of the literature

Contact Info

Product

Resources

About