Using a cervical spine cage to reconstruct malunited fibular fractures

Abstract

Purpose Anatomical reduction and fixation of unstable ankle fractures is necessary to prevent post-traumatic arthritis. Malunion of the distal fibula in unstable ankle fractures can lead to late degenerative changes of the ankle. Late reconstruction of the ankle can improve its function and postpone the need for ankle fusion or replacement. Methods We discuss three patients who presented with fibular malunion. All developed medial gutter opening, syndesmotic widening, and lateral shift and/or talar tilt. Surgery involved an anteromedial approach to clean the medial gutter, an anterolateral approach to clean the syndesmotic interval, elongation of the fibula by six to eight millimetres and stabilisation with a cervical spine cage and a locked plate. Results After one year, all patients had radiologically demonstrated reduction of the talus in the mortise. Improved function was recorded at final follow up. The cage provides several advantages over other fixation methods, including osteoconductive properties, avoiding bone graft donor site morbidity, and the range of sizes allows the surgeon to adjust the amount of elongation. Conclusions Using spinal cages to treat malunited fibula fractures has several advantages compared to bone graft and good results can be expected.

Fibular Lengthening Using the Elongated Combi-hole of a Locking Compression Plate

“…Transverse osteotomy with bone graft and plate fixation has been reported as a successful treatment for patients with fibular shortening. 1,9,18 Offierski et al 6 described good clinical results in 8 of 11 patients treated in this manner. Weber and Simpson 18 reported that among 23 patients treated with distal fibular lengthening osteotomies, 17 experienced good to excellent results at an average followup of 11 years.…”

“…8,15 Several techniques have been introduced for lateral malleolar reconstruction, including transverse, oblique, and Z-osteotomy. 1,9,10,18,19 Transverse osteotomy with bone grafting and internal fixation has been shown to effectively treat fibular shortening. 1,9,18 An AO distractor can be used to distract the osteotomy and thus achieve the correct fibular length.…”

“…1,9,10,18,19 Transverse osteotomy with bone grafting and internal fixation has been shown to effectively treat fibular shortening. 1,9,18 An AO distractor can be used to distract the osteotomy and thus achieve the correct fibular length. 16,17 After fibular osteotomy, a plate is applied to the distal fibular fragment; one arm of the distractor hooks into the proximal end of the plate, and the other arm is applied to a temporary screw inserted proximal to the plate for distraction.…”

Fibular-Lengthening Osteotomy in Patient with Progressive Valgus Deformity After an Ankle Fracture

“…The article published by Visser et al (2017) describes the completion of a fibular lengthening using a frozen allogeneic graft taken from the femoral head, which avoids the morbidity of the donor area itself [18]. In this respect, the paper by Brin et al (2013) [19] is also of interest; it presents the advantage of using cervical spine cage type devices, with excellent results as an alternative to the bone graft habitually used until now.…”