Objective To investigate the effect of microsurgical repair of refractory bone defects and nonunion in distal humers. Methods Twelve cases of bone defects and nonunion indistal humerus wererepaired with free vascularised fibular graft and fixed with the anatomical bone plate. Of the 12 cases, 8 had pseudarthrosis, and 4 had bone defects 3-5 cm. Fibular graft ranged from 5-15 cm, 8.5 cm in average. Results After a follow-up of 3-18 months, 8.5 months in average, all cases of free vascularised fibular graft healed within 38 months. The fibular graft thickenedas time passed. Normal recessive osseous elbow joint, improvement in the inflection and extension of elbow joint, and normal revolving of antebrachium were attained. The short of limbs were corrected. Satisfactory functions of supporting and fine operation were attained. Conclusion With the support of anatomical bone plate, the fibular graft can help the recovery of joint functionand repair bone defects and nonunion as to avoid joint replacement with prosthesis.
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.
ObjectiveTo explore the clinical application and effectiveness of antibiotic-loaded cement spacer combined with free fibular graft in the staged treatment of infectious long bone defect in the lower extremity.
MethodsA retrospective analysis was made on the clinical data from 12 patients with infectious long bone defect in the lower extremity between June 2010 and June 2012. Of the 12 cases, there were 9 males and 3 females with an average age of 33 years (range, 19-46 years), including 3 cases of femoral shaft bone defect, 7 cases of tibial shaft bone defect, and 2 cases of metatarsal bone defect. The causes were traffic accident injury in 7 cases, crashing injury in 3 cases, and machine extrusion injury in 2 cases. The length of bone defect ranged from 6 to 14 cm (mean, 8 cm). The soft tissue defect area ranged from 5.0 cm×3.0 cm to 8.0 cm×4.0 cm companied with tibial shaft and metatarsal bone defect in 9 cases. The sinus formed in 3 femoral shaft bone defects. The time between injury and operation was 1-4 months (mean, 2 months). At first stage, antibiotic-loaded cement spacer was placed in the bone defect after debridement and the flaps were used to repair soft tissue defect in 9 cases; at second stage (6 weeks after the first stage), defect was repaired with free fibular graft (7-22 cm in length, 14 cm on average) after antibiotic-loaded cement spacer removal. The area of the cutaneous fibular flap ranged from 6.0 cm×4.0 cm to 10.0 cm×5.0 cm in 10 cases.
ResultsAll wounds healed by first intention, and the healing time was 12-18 days, 14 days on average. Twelve cases were followed up 12-36 months (mean, 17 months). Bone healing time ranged from 4 to 6 months (5.5 months on average). The cutaneous fibular flap had good appearance. The function at donor site was satisfactory; no dysfunction of the ankle joint or tibial stress fracture occurred after operation. The mean Enneking score was 25 (range, 20-28) at last follow-up.
ConclusionInfection can be well controlled with the antibiotic-loaded cement spacer during first stage operation, and free fibular graft can increase the bone defect healing rate at second stage. Staged treatment is an optimal choice to treat infectious long bone defect in the lower extremity.
Objective To investigate a new operative method to reconstruct wrist joint for treating the defect of the distal radius after excision of tumor.Methods From October 1999 to December 2001, 3 cases of giant cell tumor in the distal radius were resected and the wrist joint was reconstructed by transplanting the fibular head pedicled with the lateral inferior genicular artery. ResultsAfter followed up for 6 to 18 months, all patients achieved the bony healing within 4 months without tumor relapse and had good function of the wrist joint. Conclusion This operation is simple and reliable. The fibularhead can be cut according to the tumor size of the radius.
ObjectiveTo review the research progress in the treatment of proximal humeral fractures with fibular allograft and locking plate.MethodsThe literature about the treatment of proximal humeral fractures with fibular allograft and locking plate was reviewed and analyzed from the aspects such as the biomechanics, imaging prognosis, and clinical prognosis.ResultsFibular allograft and locking plate can provide effective medial support for proximal humeral fracture and increase the strength of internal fixation system. Compared with locking plate, fibular allograft combined with locking plate can maintain better humeral neck-shaft angle and the humeral head height after operation in the treatment of proximal humeral fractures, and has better shoulder mobility and shoulder joint function, and does not increase the risk of complications.ConclusionFibular allograft combined with locking plate may be a new and effective treatment for proximal humeral fractures. However, the long-term follow-up results are insufficient, the final outcome of fibula is uncertain, and the long-term potential adverse reactions caused by this treatment are still indefinite.
Objective To compare the long-term results of vascularised fibulargraft and simple autologous fibular graft for reconstruction of wrist after distal bone tumor resection.Methods From January 1979 to September2002, 15 patients with wrist defects due to distal bone tumor resection were treated with vascularised fibular graft or simple autologous fibular graft and followed up 1 year. The results were graded with Enneking’s system and evaluated radiographicallyaccording to the “International Symposium on Limb Salvage”. The grade system included limb function, radiological examination and the function of ankle. Results The limb function of 8 patients with vascularised fibular graft restored to 80% of normal function and the bone union was achieved within 6 months. The limbfunction of 6 patients with simple autologous fibular graft restored to 67% of normal function. The bony union was achieved within 6 months in 4 cases with thebone graft less than 5 cm and in the 13th and 16th months in 2 cases with the bone graft more than 12 cm. Conclusion It is suitable to use the headof fibular boneas a substitute for the distal radius. The healing of vascularised fibular graft is very quick and haven’t the bone resorption. So in the procedure for reconstruction and limb salvage after bone tumor resection of distal radius, the free vascularised fibular graft with fibular head is an ideal substitute.
ObjectiveTo investigate the clinical results of locking-plate with an intramedullary fibular allograft for type C2 proximal humeral fracture fixation.
MethodsBetween January 2011 and August 2012, 16 patients with proximal humeral fractures (AO type C2) were treated by locking-plate with an intramedullary fibular allograft. The clinical data were retrospectively analysed. There were 5 males and 11 females with an average age of 64 years (range, 55-70 years). The injury causes were falling injury in 12 cases, traffic accident injury in 3 cases, and sports injury in 1 case. The duration between injury and operation ranged from 2 to 6 days (mean, 4.5 days). The imaging data were used to judge the fracture healing, and to measure the neck-shaft angle and the height of humeral head; the disability of arm, shoulder, and hand (DASH) score, short-form 36 health survey scale (SF-36), and Neer score were used to evaluate the function of the shoulder after surgery.
ResultsPrimary healing of incision was obtained in all patients; no complication of vascular and nerve injury occurred. Sixteen cases were followed up 12-24 months (mean, 18 months). All fractures healed at 18-24 weeks (mean, 20 weeks). No complication occurred as follows:re-displacement, necrosis, rejection reaction, and loosening or extraction of screws. At last follow-up, the neck-shaft angle was 126.6-136.9° (mean, 132.5°), showing a little lost when compared with intraoperative angle (130.5-138.0°, 134.0° on average). At 12 months after surgery, the height loss of humeral head was 1.8-4.6 mm (mean, 2.0 mm); the passive anteflexion of the shoulder was 130-160° (mean, 148°); the active anteflexion was 120-145° (mean, 136°); the external rotation was 30-65° (mean, 56°); the internal rotation was 15-25° (mean, 19°). And the DASH score was 2-53 (mean, 12); the SF-36 score was 50-95 (mean, 89). According to Neer score for shoulder function, the results were excellent in 10 cases, good in 4 cases, fair in 1 case, and poor in 1 case, with an excellent and good rate of 87.5%.
ConclusionLocking-plate with an intramedullary fibular allograft for type C2 proximal humeral fracture fixation has satisfactory clinical results because of stable fixation, high clinical outcome scores, and low internal fixation failure.
OBJECTIVE: To explore the anatomical basis of blood supply and heel reconstruction by reversed island fibular musculocutaneous flap. METHODS: The blood supply of fibular musculocutaneous flap and the biomechanical characteristics of heel were studied by anatomical examination. One case with right heel full defect because of explosion injury was repaired by transfer of reversed island fibular vessels. The fibular flap was 14 cm in length with part of peroneus muscle and long flexor muscle of great toe. RESULTS: The lower part of fibular artery had plentiful anastomosis with anterior tibial artery and posterior tibial artery, which could provide ideal reversed blood supply. The rotatory point of vessel pedicle could be chosen according to the need of operation. The lowest site might be above 6 cm to lateral malleolus, and the vessel pedicle was 20 cm in length. The morphological feature of the reversed island fibular musculocutaneous flap was suitable to the biomechanical character of heel. The patient achieved satisfactory clinical result, the musculocutaneous flap survived well for 10 months of follow-up. CONCLUSION: The reversed island fibular musculocutaneous flap provide a new method for repairing the severe heel defect, especially in full defect of calcaneus and cuboid bone.
To provide anatomical evidences for the blood supply compound flap based on fibular head to rebuild internal malleolus. Methods The morphology of vessels and bones in donor site and in recipient site was observed. The materials for the study were l isted as follows: ① Forty desiccative adult tibias (20 left and 20 right respectively) were used to measure the basilar width, middle thickness, anterior length, posterior length and introversion angle of internal malleolus; ② Forty desiccative adult fibulas (20 left and 20 right respectively) were used to measure the middle width and thickness, as well as the extraversion angle of articular surface of fibular head; ③ Thirty adult lower l imb specimens which perfused with red rubber were used to observe the blood supply relationships between the anterior tibial recurrent vessels and fibular head, and internal anterior malleolar vessels inside recipient site. Results The internal malleolus had a basilar width of (2.6 ± 0.2) cm, a middle thickness of (1.3 ± 0.2) cm, an anterior length of (1.4 ± 1.9) cm and a posterior length of (0.6 ± 0.1) cm. Its articular facet was half-moon. Its introversion angle was (11.89 ± 3.60)°. The fibular head had a middle thickness of (1.8 ± 0.6) cm, a middle width of (2.7 ± 0.4) cm. Its articular facet was toroid, superficial and cavate in shape, and exposed inwardsly and upwardsly, and had a extraversion angel of (39.2 ± 1.3)°. The anterior tibial recurrent artery directly began from anterior tibial artery, accounting for 93.3%. Its initiation point was (4.5 ± 0.7) cm inferior to apex of fibular head. Its main trunk ran through the deep surface of anterior tibial muscle, and ran forwards, outwards and upwards with sticking to the lateral surface of proximal tibia. Its main trunk had a length of (0.5 ±0.2) cm and a outer diameter of (2.0 ± 0.4) mm. Its accompanying veins, which had outer diameters of (2.1 ± 0.5) mm and (2.6 ± 0.4) mm, entry into anterior tibial vein. It constantly gave 1-2 fibular head branches which had a outer diameter of (1.7 ± 1.3) mm at (1.0 ± 0.4) cm from the initiation point. The internal anterior malleolar artery which began from anterior tibial artery or dorsal pedal artery had a outer diameter of (1.6 ± 0.4) mm. Its accompanying veins had outer diameters of (1.3 ± 0.5) mm and (1.1 ± 0.4) mm. Conclusion The blood supply compound flap based on fibular head had a possibil ity to rebuild internal malleolus. Its articular facet was characterized as the important anatomical basis to rebuild internal malleolus.
ObjectiveTo investigate the effects of fibular head resection in prosthetic replacement for neoplasms of the proximal tibia in limb salvage surgery.
MethodsBetween July 1999 and March 2013, 76 patients with neoplasms of the proximal tibia underwent tumor resection, prosthetic replacement, and gastrocnemius medial head flap transfer. Among them, 38 patients underwent fibular head resection (group A) and 38 underwent fibular head preservation (group B). There was no significant difference in gender, age, side, tumor classification and stage, and disease duration between 2 groups (P>0.05). The complications and the position of the components were observed, and American society for bone tumors scoring system (MSTS93) was used to evaluate the joint function.
ResultsAll patients were followed up 12-150 months (mean, 87 months). Incision infection occurred in 1 patient (2.63%) of group A and 6 patients (15.79%) of group B, showing significant difference (χ2=3.934, P=0.047). Necrosis of gastrocnemius medial head flap was found in 1 patient of group A and 2 patients of group B. Prosthetic loosening and instability of the knee were observed in 4 and 2 cases of group A and in 6 and 4 cases of group B, respectively. In groups A and B, there were 3 and 5 cases of local recurrence, 7 and 6 cases of distant metastasis, and 8 and 7 deaths, respectively. According to MSTS93, the results were excellent in 23 cases, good in 10 cases, fair in 3 cases, and poor in 2 cases, with an excellent and good rate of 86.84% in group A; the results were excellent in 21 cases, good in 11 cases, fair in 3 cases, and poor in 3 cases, with an excellent and good rate of 84.21% in group B; and no significant difference was found in the excellent and good rate between 2 groups (χ2=0.106, P=0.744).
ConclusionFibular head resection in prosthetic replacement for neoplasms of the proximal tibia in limb salvage surgery is beneficial to intra-operative tissue coverage, and it can reduce trauma by skin transplantation and related complications. Good stability and motion of the joint can be obtained after operation.
