MyMedR

Severe Cervicothoracic Kyphoscoliosis in Neurofibromatosis - A Failure Of Posterior-Only Instrumentation: A Case Report

Soh E, Muhamad-Ariffin MH, Baharudin A

Malays Orthop J, 2020 Mar;14(1):88-91.

PMID: 32296489 DOI: 10.5704/MOJ.2003.015

Treatment of severe spinal deformities associated with neurofibromatosis has proven to be challenging. An 11-year-old girl, with neurofibromatosis and severe cervicothoracic kyphoscoliosis, was initially treated with posterior instrumentation and fusion. Implant failure developed within a year, requiring an anterior stabilisation and fusion with a non-vascularised fibular strut graft for better stability and increased likelihood of achieving union. The posterior instrumentation was removed due to its prominence and wound breakdown. Following the removal of the posterior implant, the fibular graft fractured. The patient was maintained on a cervical collar until union was achieved. Posterior spinal fusion alone in severe spinal deformities in neurofibromatosis has a high risk of failure. A combined anterior and posterior fusion may increase the chance of success, with better stability and union rate.

Matched MeSH terms: Fibula

Fulltext Skin paddle as an indicator of the viability of vascularised fibular graft

Imran Y, Zulmi W, Halim AS

Singapore Med J, 2004 Mar;45(3):110-2.

PMID: 15029411

Immediate recognition of anastomotic failure is important to ensure the viability of the vascularised fibular graft. The problems associated with post-operative bone scanning and angiography for immediate detection of anastomotic failure have been described.

Matched MeSH terms: Fibula/blood supply; Fibula/radionuclide imaging; Fibula/transplantation*

Fulltext Reconstruction of the Second Metatarsal with Non-vascularised Fibular Graft following En-bloc Resection for Giant Cell Tumour: A Case Report

Rengsen P, Tiong K, Teo Y, Goh T, Sivapathasundram N

Malays Orthop J, 2013 Nov;7(3):15-7.

PMID: 25674301 DOI: 10.5704/MOJ.1311.001

Giant cell tumour in the metatarsal of a skeletally immature person is uncommon. Adequate surgical resection in this region can be difficult to achieve as there is little space between the rays of the foot. Furthermore, there is the challenge of restoring the metatarsophalangeal articulation after resection of the tumor. We describe a technique using non-vascularised fibular graft for reconstructing the 2nd metatarsal after en-bloc resection for giant cell tumour in a 14 year old adolescent female.

Matched MeSH terms: Fibula

Reconstruction of a tibial defect with a previously fractured fibula including the fractured segment as a free osteoseptocutaneous flap

Sadek AF, Halim AS, Ismail FW, Imran YM

Ann Plast Surg, 2014 Oct;73(4):402-4.

PMID: 23851368 DOI: 10.1097/SAP.0b013e31827fb387

Reconstruction of major bone defects using free fibular transfer provides a good biological option in unsound situations. Most authors recommend selection of the recipient blood vessels outside the zone of injury to achieve successful free fibular transfer. Occasionally, in polytraumatized patients, the surgeon has to use a previously fractured fibula as a graft, with increased risk of inclusion of the injury zone that may lead to failure.

Matched MeSH terms: Fibula/injuries; Fibula/transplantation*

Fulltext Peroneal nerve palsy secondary to proximal fibular osteochondroma--a case report

Hazmy W

Med J Malaysia, 2001 Jun;56 Suppl C:89-90.

PMID: 11814260

The author reports a case of a 11-year old child presented with peroneal nerve entrapment secondary to proximal fibular osteochondroma, with complete recovery of function following the excision of the tumor.

Matched MeSH terms: Fibula/radiography; Fibula/surgery*

Mandibular reconstruction: experience with the free vascularized fibula transfer

Khanijow VK, Ahmad TS, Lian CB, Jalaludin MA

Microsurgery, 1993;14(6):375-9.

PMID: 8371683

Mandibular resection, following surgery for tumor or osteoradionecrosis, leaves a patient with a swallowing, speech, and cosmetic disability. Repair of the oromandibular defect is difficult and various prostheses and grafts have been used and reported. The most popular form of mandibular reconstruction is the use of the free, vascularized bone transfer. We report our experience with the free vascularized fibula bone transfer in eight patients.

Matched MeSH terms: Fibula/blood supply; Fibula/transplantation*

Fractures of the tibia and fibula. A follow-up study of the initial 64 patients treated at the University Hospital, Kuala Lumpur, Malaysia

Silva JF

J Trauma, 1972 Dec;12(12):1029-40.

PMID: 4568503

Matched MeSH terms: Fibula/injuries*; Fibula/radiography

Fulltext Skeletal union following long bone reconstruction using vascularised fibula graft

Imran Y, Zulmi W, Halim AS

Singapore Med J, 2003 Jun;44(6):286-7.

PMID: 14560858

Thirteen patients had skeletal reconstruction using vascularised fibula graft following resection of the diseased bone. Eleven patients had reconstruction of the lower limbs and two patients of the upper limbs. Clinical and radiographical evidence union were achieved with the average time of 32 weeks (earliest eight weeks). Six out of 11 patients (54%) in lower limb reconstruction started weight bearing at the average of 27 weeks. Bony union in this study is comparable with other studies using vascularised fibula graft.

Matched MeSH terms: Fibula/blood supply; Fibula/transplantation*

Fulltext Free non-vascularized fibular graft for treatment of pediatric traumatic radial bone loss: a case report

Thevarajan K, Teo P

Malays Orthop J, 2013 Jul;7(2):37-40.

PMID: 25722825 MyJurnal DOI: 10.5704/MOJ.1307.003

Various methods, such as vascularized bone transfers, Illizarov bone transport, allogenic bone grafts, bone graft substitutes, are available in treating traumatic bone loss. Free non-vascularised fibular graft is an autografting method that only requires minimal facilities or expertise. However, this method is not popularized due to its avascular property and there is not many reports regarding its use in treating a large traumatic bone loss. We reported a case in our center to demonstrate its possibility of successfully treating the traumatic radial bone loss in pediatric patient. Patient had good recovery with the regain of good range of movement of forearm and there is no harvest site morbidity after two years of follow up.

Matched MeSH terms: Fibula

Fulltext Reconstruction of the second metatarsal with nonvascularised fibular graft following en-bloc resection for giant cell tumour: A case report

Rengsen, P., Tiong, K.L., Teo, Y.M., Goh, T.C., Sivapathasundram, N.

Malays Orthop J, 2013;7(3):15-17.

MyJurnal

Giant cell tumour in the metatarsal of a skeletally immature person is uncommon. Adequate surgical resection in this region can be difficult to achieve as there is little space between the rays of the foot. Furthermore, there is the challenge of restoring the metatarsophalangeal articulation after resection of the tumor. We describe a technique using non-vascularised fibular graft for reconstructing the 2nd metatarsal after en-bloc resection for giant cell tumour in a 14 year old adolescent female.

Matched MeSH terms: Fibula

Fulltext Fibula Osteocutaneous Flap for Mandible Reconstruction after Ameloblastoma Resection: Amending Technique to Reduce Ischaemic Time

Chee, E.K., Sara Ahmad, T., Ng, E.S.

Malays Orthop J, 2007;1(1):39-41.

MyJurnal

A 27-year-old patient with ameloblastoma of the mandible
underwent anterior mandibulectomy and reconstruction with
left fibula osteocutaneous flap. The bone was shaped at the
lower limb before cutting the pedicle. Vascularised free fibula flap provides a good alternative to other bone grafts in mandible reconstruction as it is relatively easy to perform, carries a low complication rate, and mandibular shaping with intact pedicle cuts down on ischaemic as well as total operative time.

Matched MeSH terms: Fibula

Fulltext Primary Osteosarcoma of the Distal Fibula treated with Distal Fibulectomy with a Five-Year Follow-up: A Case Report

Saadon I, Amit B, Zolquarnian A, Muhamad F

Malays Orthop J, 2017 Jul;11(2):64-67.

PMID: 29021882 MyJurnal DOI: 10.5704/MOJ.1707.010

Musculoskeletal tumours of the lower limbs especially malignant tumours are not common. The fibula is the site of primary bone tumours as reported in 2.4% of lower limb tumours with the proximal third being more frequently involved than the distal segment. Osteosarcoma is the most common primary malignant bone tumour of nonhaematopoietic origin, with distal fibular involvement in 0.47% of patients. The advances in imaging techniques and neo-adjuvant chemotherapy have now made it possible to accurately define the extent of tumour and plan limb salvage with tumour resection. The purpose of this case report is to highlight the successful outcome of limb salvage procedure with a five year follow up in an 11-year old boy with distal fibular osteosarcoma. Limb salvage surgery with distal fibulectomy and retention of the foot are a good alternative to radical amputation.

Matched MeSH terms: Fibula

Minimum level of jumping exercise required to maintain exercise-induced bone gains in female rats

Ooi FK, Singh R, Singh HJ, Umemura Y

Osteoporos Int, 2009 Jun;20(6):963-72.

PMID: 18839049 DOI: 10.1007/s00198-008-0760-6

SUMMARY: This study determines the minimum level of exercise required to maintain 8 weeks of jumping exercise-induced bone gains in rats. It was found that the minimum level of exercise required for maintaining the different exercise-induced bone gains varied between 11% and 18% of the initial exercise intensity.

INTRODUCTION: This study ascertains the minimum level of follow-up exercise required to maintain bone gains induced by an 8-week jumping exercise in rats.

METHODS: Twelve groups of 12-week old rats (n = 10 rats per group) were given either no exercise for 8 (8S) or 32 weeks (32S), or received 8 weeks of standard training program (8STP) that consisted of 200 jumps per week, given at 40 jumps per day for 5 days per week, followed by 24 weeks of exercise at loads of either 40 or 20 or 10 jumps per day, for either 5, or 3, or 1 day/week. Bone mass, strength, and morphometric properties were measured in the right tibia. Data were analyzed using one-way analyses of variance.

RESULTS: Bone mass, strength, mid-shaft periosteal perimeter and cortical area were significantly (p < 0.05) higher in the rats given 8STP than that in the 8S group. The minimal level of exercise required to maintain the bone gains was 31, 36, 25, and 21 jumps per week for mass, strength, periosteal perimeter and cortical area, respectively.

CONCLUSIONS: Eight weeks of jumping exercise-induced bone gains could be maintained for a period of 24 weeks with follow-up exercise consisting of 11% to 18% of the initial exercise load.

Matched MeSH terms: Fibula/physiology

Long-term outcome of free fibula osteocutaneous flap and massive allograft in the reconstruction of long bone defect

Halim AS, Chai SC, Wan Ismail WF, Wan Azman WS, Mat Saad AZ, Wan Z

J Plast Reconstr Aesthet Surg, 2015 Dec;68(12):1755-62.

PMID: 26420474 DOI: 10.1016/j.bjps.2015.08.013

Reconstruction of massive bone defects in bone tumors with allografts has been shown to have significant complications including infection, delayed or nonunion of allograft, and allograft fracture. Resection compounded with soft tissue defects requires skin coverage. A composite osteocutaneous free fibula offers an optimal solution where the allografts can be augmented mechanically and achieve biological incorporation. Following resection, the cutaneous component of the free osteocutaneous fibula flaps covers the massive soft tissue defect. In this retrospective study, the long-term outcome of 12 patients, who underwent single-stage limb reconstruction with massive allograft and free fibula osteocutaneous flaps instead of free fibula osteal flaps only, was evaluated. This study included 12 consecutive patients who had primary bone tumors and had follow-up for a minimum of 24 months. The mean age at the time of surgery was 19.8 years. A total of eight patients had primary malignant bone tumors (five osteosarcomas, two chondrosarcomas and one synovial sarcoma), and four patients had benign bone tumors (two giant-cell tumors, one aneurysmal bone cyst, and one neurofibromatosis). The mean follow-up for the 12 patients was 63 months (range 24-124 months). Out of the 10 patients, nine underwent lower-limb reconstruction and ambulated with partial weight bearing and full weight bearing at an average of 4.2 months and 8.2 months, respectively. In conclusion, augmentation of a massive allograft with free fibula osteocutaneous flap is an excellent alternative for reducing the long-term complication of massive allograft and concurrently addresses the soft tissue coverage.

Matched MeSH terms: Fibula/transplantation*

Ankle reconstruction and lengthening strategy in type II fibular hemimelia: a report of two cases

Sulaiman AR, Munajat I, Mohd EF

Foot (Edinb), 2018 Sep;36:6-9.

PMID: 30041040 DOI: 10.1016/j.foot.2018.01.001

Limb lengthening of fibular hemimelia is associated with progressive ankle valgus deformity. We reported a successful tibial lengthening in fibular hemimelia without recurrence of ankle valgus in 2 cases. The procedure involved 2 stages. First stage was a resection of the fibular remnant followed by a bending osteotomy through the distal tibial physis before the age of 2 years old. The second stage was a tibia lengthening up to 25% of its original segmental length performed at the age of 5 years old. There was neither progressive ankle valgus nor distal tibial growth arrest observed at 4 years follow-up.

Matched MeSH terms: Fibula*

Composite vascularised osteocutaneous fibula and sural nerve graft for severe open tibial fracture--functional outcome at one year: a case report

Halim AS, Yusof I

J Orthop Surg (Hong Kong), 2004 Jun;12(1):110-3.

PMID: 15237132

Management of severe open tibial fracture with neurovascular injury is difficult and controversial. Primary amputation is an acceptable option as salvaging the injured, insensate, and ischaemic limb may result in chronic osteomyelitis and non-functional limb. We report a case of open tibial fracture associated with segmental bone and soft tissue loss, posterior tibial nerve and artery injuries, which was further complicated by chronic osteo-myelitis treated with composite vascularised osteocutaneous fibula and sural nerve graft. Functional outcome of the injured limb at one-year follow-up was satisfactory: the patient was capable of achieving full weightbearing and was able to appreciate crude touch, pain, proprioception, and temperature at the plantar aspect of the foot. There was no pressure sore or ulceration.

Matched MeSH terms: Fibula/blood supply*; Fibula/injuries; Fibula/surgery; Fibula/transplantation*

Fulltext Early complication following long bone reconstruction using vascularised fibula graft

Imran Y, Zulmi W, Halim AS

Med J Malaysia, 2004 Dec;59 Suppl F:35-8.

PMID: 15941158

Long bone reconstruction using vascularized fibula graft is becoming more popular despite the difficulties and its post-operative complications. We reviewed our early experience dealing with vascularized fibula graft for the management of massive long bone defect. Thirteen patients had undergone long bone reconstruction using vascularized fibula graft. Early complications that had been encountered include superficial wound infection (23%), transient common peroneal nerve palsy (23%), stage 1 bed sore (7.7%), anastomotic venous thrombosis (30.8%), DIVC (15.4%), flap loss and amputation (7.7%), and reactive psychiatric problem (7.7%). The early complications following this procedure are comparable with other major orthopaedic surgery and most of them are minor and treatable. The complication rates are also comparable with similar surgery done elsewhere.

Matched MeSH terms: Fibula/blood supply; Fibula/transplantation*

Fulltext Chronic Osteomyelitis Revisited: A Case Report

Chuah SK, Bajuri MY, Mohd Nor F

Cureus, 2019 Jun 28;11(6):e5023.

PMID: 31501722 DOI: 10.7759/cureus.5023

Chronic osteomyelitis treatment is always a challenge to orthopaedic surgeons which requires great dedication and perseverance. We report a successful limb salvage case of a 46-year-old man who suffered from a left tibia chronic osteomyelitis with soft tissue defect. The treatment approach was a thorough wound debridement of devitalized tissues and necrotized bone, commencement of culture-directed antibiotics, reconstruction with vascularized osteomyocutaneous fibula flap, and skeletal stabilization with internal fixation. As compared to below knee amputation, the result we obtained in this case is more promising with regard to mobility and function.

Matched MeSH terms: Fibula

Fulltext Functional Outcome after Treatment of Aggressive Tumours in the Distal Radius: Comparison between Reconstruction using Proximal Fibular Graft and Wrist Fusion

Choo CY, Mat-Saad AM, Wan-Azman WS, Wan Z, Nor-Azman MZ, Yahaya S, et al.

Malays Orthop J, 2018 Nov;12(3):19-23.

PMID: 30555642 MyJurnal DOI: 10.5704/MOJ.1811.004

Introduction: Restoration of a functional hand is the ultimate goal following a distal radius tumour resection. The early outcomes of mobile wrist reconstruction are satisfactory; however, long-term results are unpredictable due to late wrist instability and degenerative arthritis. Our aim is to compare mobile wrist reconstruction with wrist fusion (pan-carpal fusion) in our cohort of patients. Materials and Methods: A retrospective cohort study was performed for functional outcomes of all patients who underwent resection for distal radius tumour and treated with either fusion or reconstruction of the wrist in a single institution from years 2000-2013 with a minimum of three years follow-up. Results: Eleven patients were included in the study, six of whom had wrist reconstruction with proximal fibula graft and the remaining five wrist fusion, with a mean follow-up of 6.3 years. The mean Musculoskeletal Tumour Society (MSTS) score was 82.78%, ranging from 70% to 93.3%. Average grip strength compared to the normal contralateral hand was 60.0% for total wrist fusion, which was better than wrist reconstruction with 58.07%. There was no difference in the functional outcome between fusion and mobile reconstruction in our study. Osteoarthritis changes and subluxation of the wrist joint were the most common findings in the long-term follow-up for this group. Conclusion: There was no difference in the functional outcome of the long-term follow-up between the two groups.

Matched MeSH terms: Fibula

Usual Presentation Has Odds: Unilateral Tibial Hemimelia in One of Dizygotic Twins

Al-Chalabi MMM, Wan Sulaiman WA

Cureus, 2021 Jan 21;13(1):e12834.

PMID: 33633877 DOI: 10.7759/cureus.12834

Tibial hemimelia is a relatively rare congenital tibial longitudinal deficiency (approximately 1 per 1 million live births), unilateral or bilateral, with a relatively intact fibula. Hemimelia results from a disruption of the lower limb developmental field during embryogenesis due to slow or even abort of chondrification process, which results in leg length discrepancy. Affected leg commonly appears short and deformed with knee, ankle, and foot involvement. It may present with a variety of associated anomalies. Surgical treatment varies according to the type and degree of deformity, and reconstructive interventions are still limited. Reported cases of tibial hemimelia are very infrequent, especially tibial hemimelia in twins. Usually, the cases were in single embryo or less frequently in one of the monozygotic twins, but no reported cases regarding tibial hemimelia in one of the dizygotic twins as this article reports.

Matched MeSH terms: Fibula

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