Objective To study the reparative and reconstructive for proximal humerus defect due to the excision of bone tumor with noninternal fixation non-vascularised fibular autografts. Methods From June 1991 toDecember 2003, 26 non-vascularised fibular grafts were used as substitutes for repair and reconstruction after resection for bone tumors on proximal humerus. Fifteen cases were given curettage and fibular supporting internal fixation, the other 11 cases were given tumor resection and joint reconstruction with proximal fibular graft. The age ranged from 6 to 41 years. Out of 26 patients, 5 had giant cell tumor, 9 had bone cysts, 8 had fibrous dysplasia and 4 had enchondroma. Results Twenty-six patients were followed up from 1 to 12 years (3.4 years on average). Local recurrence was found in 2 cases, and 1 of them died of lung metastasis. Both outlook and function of the reconstructed joints have good results in 15 proximal humeral joint surface reserved cases. Of them, 3 children gained normal shoulder function 3 weeks after operation. Part function were obtained in the other 11 fibular grafts substituted proximal humeral defect. Conclusion Non-vascularised fibular grafts is an appropriate treatment option for proximal humerus bone defect due to excision of bone tumor.
Since 1979, nine children had been treated by free fibular graft in our hospital. Five of them were males, and 4 were females, with a mean age of eight years. The average length of the skeletal defects was 7 cm. The average length of the fibula that was removed for reconstruction was 12.3 cm. The blood circulation of the donor bone was re-established by direct anastomosis of one peroneal artery and vein of the transfer with the appropriate artery and vein of the host region. Nine patients had been followed from 1 year to 9 years,avereged 5.5 years. S even grafts which were substituted in the tibia defects took the same shape and caliber as that of the normal tibia with canalization of the marrow cavity . From the roentgenographic examination of the side where the fibular graft was removed, there was definite caudal migration of the upper fibular in 5 cases,averged 5.2mm,while in 7 cases there was cephalic migration of the distal fibular segments,averaged 4.3mm. The breadth of ankle mortise where increased in 7 cases,The tibio-talus angle was averaged 7 degrees,in 3 cases. In 3 of the 9 cases during follow-up,alaterl wedging of the distal tibia epiphysis with lateral tilting of the talus invarably associated with instability of the ankle was evident. We believed that the elevation of the lateral malleolus and latral wedging of the distal tibia epiphysis were responsible for instability of the ankle.
Objective
To evaluate the directional significance of SurgiCase software in free fibula mandibular reconstruction.
Methods
Between September 2010 and March 2012, 10 patients with mandibular defect underwent free fibula mandibular reconstruction. There were 7 males and 3 females, with an age range of 19-43 years (mean, 27 years). The extent of lesions was 7 cm × 5 cm to 16 cm × 8 cm. In each case, three-dimensional spiral CT scan of the maxilla, mandible, and fibula was obtained before surgery. The CT data were imported into the SurgiCase software and the virtual surgery planning was performed. After that, the mandibular rapid prototyping was made according to customized design. The reconstruction surgery was then carried out using these preoperative data. During actual surgery, the extent of mandibular defect was from 6 cm × 3 cm to 16 cm × 5 cm; the length of fibula which was used to reconstruct mandible was 6-17 cm; and the area of flap was from 6 cm × 5 cm to 16 cm × 6 cm.
Results
Preoperative data could not be applied because the intraoperative size of tumor was larger than preoperative design in 1 case of mandibular ameloblastoma, and the fibula was shaped according to the actual osteotomy location; operations were performed successfully according to preoperative design in the other 9 patients. The operation time was 5-7 hours (mean, 6 hours). Primary healing of incision was obtained, without early complications. Ten patients were followed up 1 year. At last follow-up, 8 patients were satisfactory with the appearance and 2 patients complained with unsatisfied wide facial pattern. The panoramic radiograghs showed good bone healing. The range of mouth opening was 2.5-3.5 cm.
Conclusion
SurgiCase software can provide precise data for free fibula mandibular reconstruction during surgery. It can be applied widely in clinic.
OBJECTIVE: To investigate the repairing result for the massive bony defects of upper and middle tibia and lower femur. METHODS: Since 1974, four types of pedicled-fibula transposition were performed to repair the massive bone defect of tibia and femur in 25 cases, which included; 9 cases with benign tumor of upper part of tibia were performed muscle-pedicled fibula transposition and knee fusion after tumor resection; 9 cases with extensive benign tumor or tumoroid lesion of tibia shaft were performed muscle-pedicled fibula transposition and tibia-fibula fusion after tumor resection; 2 cases with extensive benign tumor or tumoroid lesion of middle and lower parts of tibia were performed vascular pedicled fibula transposition and tibia-fibula fusion; 5 cases with benign tumor of distal femur were performed vascular pedicled fibula reversal transposition and knee fusion. RESULTS: After 3 months to 11 years follow-up, 23 cases showed bone healing at 6 months postoperatively. The other 2 cases showed bone healing at 12 months postoperatively. All cases had satisfactory functional rehabilitation. CONCLUSION: Pedicled-fibula transposition is a choice method for repairing massive defects of tibia and femur.
ObjectiveTo compare the effectiveness of Taylor spatial frame (TSF) and unilateral external fixator in the treatment of tibiofibular open fractures.MethodsBetween January 2016 and July 2018, 74 patients with tibiofibular open fracture who met the selection criteria were divided into TSF group (43 cases, fixed with TSF) and unilateral group (31 cases, fixed with unilateral external fixator) according to the principle of entering the group every other day. There was no significant difference in gender, age, affected side, cause of injury, type of fracture between the two groups (P>0.05). The operation time, fracture healing time, removal time of external fixator, and complications were recorded and compared between the two groups. The limb function was evaluated according to Johner-Wruhs criteria for evaluating the final effectiveness of tibial shaft fracture treatment. The recovery of lower limb force line was ecaluated by LUO Congfeng et al. criteria.ResultsAll patients were followed up 8-22 months, with a median of 12 months. All fractures healed, and no complication such as delayed union, nonunion, or osteomyelitis occurred. The operation time, fracture healing time, and removal time of external fixator in TSF group were significantly shorter than those in unilateral group (P<0.05). At 3 months after the removal of the external fixator, the limb function was evaluated according to the Johner-Wruhs standard. In TSF group, 41 cases were excellent, 1 case was good, and 1 case was fair, and the excellent and good rate was 97.67%; in unilateral group, 30 cases were excellent and 1 case was fair, and the excellent and good rate was 96.77%; there was no significant difference between the two groups (P=0.666). At 4 months after operation, the recovery of lower limb force line was ecaluated by LUO Congfeng et al. criterion. In TSF group, 41 cases were excellent, 2 cases were good, and 1 case was fair, and the excellent and good rate was 97.67%; in unilateral group, 29 cases were excellent, 1 case was good, 1 case was fair, and the excellent and good rate was 96.77%; there was no significant difference between the two groups (P=0.666).ConclusionFor tibiofibular open fracture, on the premise of fracture healing, TSF technology is superior to unilateral external fixation in terms of shortening operation time, fracture healing time, and removal time of external fixator.
Objective To investigate the method and the cl inical outcomes of reconstruction of the knee stability after resection of tumors of the proximal fibula. Methods The cl inical data were retrospectively analyzed, from 16 patients with tumors of the proximal fibula undergoing proximal fibular resections and reconstructions of the lateral collateral ligament and the tendon of the biceps femoris with anchors between January 2008 and December 2009 (test group). Five patients underwent proximal fibular resection but were not given reconstruction surgery at the same period as the control group. There was no significant difference in gender, ages, disease duration, and tumor site between 2 groups (P gt; 0.05). Lateral stress test was performed after operation; X-ray films were taken to measure the joint space. Musculoskeletal Tumor Society (MSTS) functional score system was used to evaluate the joint function. Results All incisions healed by first intention in 2 groups. Iatrogenic complete peroneal nerve function loss occurred in patients undergoing Malawer type II surgical resection. The patients in both groups were followed up 12 to 36 months, with an average of 30 months. One patient with osteosarcoma of the test group developed local recurrence, and died of lung and systemic metastases after 12 months; the other patients had no recurrence. At last follow-up, the results of knee lateral stress test were negative in the test group, and the joint space increased and was classified as grade A; the results of knee lateral stress test were positive in the control group, and the joint space was classified as grade D. The MSTS score was 97.5 ± 3.5 in the test group and 87.5 ± 3.5 in the control group, showing significant difference (t=2.85, P=0.01). Conclusion The reconstruction of the bony attachment of the lateral collateral ligament and the tendon of the biceps femoris with anchors after resection of the proximal fibula is a safe, rel iable, and simple technique to reconstruct knee stabil ity after resection of tumors of the proximal fibula.
Objective
To investigate the effect of axial stress stimulation on tibial and fibular open fractures healing after Taylor space stent fixation.
Methods
The data of 45 cases with tibial and fibular open fractures treated by Taylor space stent fixation who meet the selection criteria between January 2015 and June 2016 were retrospectively analysed. The patients were divided into trial group (23 cases) and control group (22 cases) according to whether the axial stress stimulation was performed after operation. There was no significant difference in gender, age, affected side, cause of injury, type of fracture, and interval time from injury to operation between 2 groups (P>0.05). The axial stress stimulation was performed in trial group after operation. The axial load sharing ratio was tested, and when the value was less than 10%, the external fixator was removed. The fracture healing time, full weight-bearing time, and external fixator removal time were recorded and compared. After 6 months of external fixator removal, the function of the limb was assessed by Johner-Wruhs criteria for evaluation of final effectiveness of treatment of tibial shaft fractures.
Results
There were 2 and 3 cases of needle foreign body reaction in trial group and control group, respectively, and healed after symptomatic anti allergic treatment. All the patients were followed up 8-12 months with an average of 10 months. All the fractures reached clinical healing, no complication such as delayed union, nonunion, or osteomyelitis occurred. The fracture healing time, full weight-bearing time, and external fixator removal time in trial group were significantly shorter than those in control group (P<0.05). After 6 months of external fixator removal, the function of the limb was excellent in 13 cases, good in 6 cases, fair in 3 cases, and poor in 1 case in trial group, with an excellent and good rate of 82.6%; and was excellent in 5 cases, good in 10 cases, fair in 4 cases, and poor in 3 cases in control group, with an excellent and good rate of 68.2%, showing significant difference between 2 groups (Z=–2.146, P=0.032).
Conclusion
The axial stress stimulation of Taylor space stent fixation can promote the healing of tibial and fibular open fractures and promote local bone formation at fracture site.
Objective To evaluate the clinical effects of fibula flap grafts on the repair of the extremities with traumatic compound tissue defects. Methods In 12 cases, the fibula flap grafts were employed to restore the extremities with traumatic compound tissue defects. Of the 12 patients, 9 were males, 3 were females; their ages ranged from 12 to 45. There were 2 cases of tibia defect combined with fibula fracture, 2 cases of tibia defect, 2 cases of radius defect, 3 cases of ulna defect, 1 case of calcaneus defect,and 2 cases of firstmetatarsus defect. The bone defect length ranged from 4.2 to 10.6 cm, 7.8 cm in average.The skin defect area ranged from 10.0 cm×4.5 cm to 27.0 cm×15.0 cm. The free transplantation of fibular flaps were used in 9 cases, the lapse operation were used in 2 cases, retrograde shift were used in 1 case. Results Postoperational vein crisis and commonperoneal nerve traction injury were observed in category mentioned above respectively. All the 12 fibula flaps survived after proper treatments such as removalof great saphenous vein. Follow-ups were done for 6 to 24 months. Both the transferred fibula and the recipient broken end reflected bones were healed. Four patients underwent the second-phase reconstruction operation oftendon moving power. One wrist and 1 ankle underwent arthrodesis in 3 to 6 months.All the effects were satisfactory. Conclusion The fibula flap grafts provide arelatively better alternative to repair the extremities with long bone compoundtissue defects. In addition, the sensory function reconstruction of fibula flaps should be given full attention.
OBJECTIVE To investigate a good method for repairing the long bone defect of tibia combined with soft tissue defect. METHODS From 1988-1998, sixteen patients with long bone defect of tibia were admitted. There were 12 males, 4 females and aged from 16 to 45 years. The length of tibia defect ranged from 7 cm to 12 cm, the area of soft tissue defect ranged from 5 cm x 3 cm to 12 cm x 6 cm. Free fibula grafting was adopted in repairing. During operation, the two ends of fibular artery were anastomosised with the anterior tibial artery of the recipient, and the composited fibular flap were transplanted. RESULTS All grafted fibula unioned and the flap survived completely. Followed up for 6 to 111 months, 14 patients acquired the normal function while the other 2 patients received arthrodesis of the tibial-talus joint. In all the 16 patients, the unstable ankle joint could not be observed. CONCLUSION The modified method is characterized by the clear anatomy, the less blood loss and the reduced operation time. Meanwhile, the blood supply of the grafted fibula can be monitored.
Objective To probe the repair method and effect of freesegmented-fibula transplantation to treat chronic osteomyelitis complicated by long bone defect in tibia in the first intention. Methods From March 1996 to December 2003, 67 cases of chronic osteomyelitis complicated by long bone defect were reconstructed with vascularized fibula graft after the long inflammable bone and soft tissue focus were resected. Their age ranged from 8 to 42 years. The course of disease was 6 months to 8 years. There were 14 cases of hematogenous osteomyelitis and 53 cases of traumatic osteomyelitis. Of them, 18 cases complicated by fracture of fibula; 21 cases by defect of skin ( 2 cm×4 cm-4 cm×10 cm) and bone exposure;53 cases by pathological fracture and nonunion; and 46 cases by 1-3 fistula of osteomyelitis. The length of bone defect was from 8 cm to 22 cm(mean 12 cm), andthegermiculture results of all cases were positive. Forty-six cases were treated with vascularized fibula graft, the other 21 cases with the skin flap. The segmentedfibula was 10-28 cm, skin flap size was 4 cm×7 cm6 cm×12 cm. Results After a follow-up of 12-45 months, the healing rate of sinus was 93.5% while the 6.5% remainders healed by the second sinus cleaning-up. The graft bone healed after 4-6 months(mean 4.2 months) by X-ray examination. The limb inflammation was controlled after 2 weeks.All 21 skin flaps all survived and the function recovery of affectedlimb was 79% of normal limbs according to Enneking evaluation system, but 2 patients occurred secondary fracture. The act or process of augmenting of tibia under 18-year-old cases were sooner than those who were more than 18-year-old. Conclusion It is a choice to repair the chronic osteomyelitis complicated by longbone defect with vascularized fibula graft in the first intention. The operation to reconstruct long bone defect is a good method to control inflammation efficiently, shorten period of treatment and reduce the time of operation.
