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At least 19 recordsLinked to original sources

PubMed1992

Biomechanical study on the load-bearing characteristics of the fibula and the effects of fibular resection.

The objective of this research was to investigate the load-bearing function of the fibula in relation to donor leg morbidity in patients who have had fibular resections. Biomechanical loading experiments were performed on ten anatomic specimens. Force transducers were mounted in place of resected tibial and fibular segments to allow load transmission to be measured. Load transmission through the fibula varied with ankle position. With the ankle at neutral position, the load distribution to the fibula averaged 7.12% of the total force transmitted through the tibia and fibula. Maximum loads occurred at full dorsiflexion and eversion. Resection of the proximal fibula results in a significant reduction of load through the distal fibular remnant. The values varied between 0.62% and 0.81% of the total force transmitted. When a cortex screw was introduced to anchor the distal fibula remnant to the tibia, the load distribution to the distal fibula remnant was partially restored with values ranging from 1.71% to 5.14% of the total force transmitted depending on the different ankle positions. These observations suggest that more consideration of the loading characteristics of the fibula should be taken into account in planning resection operations.

Biomechanical Phenomena↗

PubMed1979

[Margins and torsion of the human fibula].

The borders and ridges of the fibula show a difficult aspect caused by the bone-forming musculature. These structures are an occasion for misunderstanding and mistaken denominations, which even had a noticeable effect on the PNA. Two thirds of all human fibulae exhibit a clearly prominent 'crista musculi tibialia posterioris', giving tendinuous attachment to the tibialis posterior muscle. In diagnosis of borders this crista may lead to errors, because it branches off from the interosseous border underneath the upper fourth of the fibula and reaches the medial crest in the middle of the bone. Most of the borders of the fibula show a twisted course corresponding to the direction of the shaping musculature and effecting a fictitious torsion of the shaft. The proper torsion of the fibula, however, is substantiated by the difference between the absolute torsion (= twist of the two ends of the bone) and the accompanying torsion (= twist enforced by the torsion of the tibia).

Biomechanical Phenomena↗

PubMed1992

The osteocutaneous fibula flap: an anatomic study.

Recent studies related to the fibula flap have disagreed regarding the anatomy of the cutaneous branches of the peroneal artery. To clarify this issue, various dissections of 35 injected fresh cadaver legs were done. Identifiable skin branches were found in 23 of 25 dissections. Skin branches from the proximal third of the peroneal artery always travelled an intramuscular course. Skin branches from the distal two-thirds of the peroneal artery were usually affixed to the posterior crural septum. Legs with peroneal artery skin branches had from three to seven branches (average: 4.7); each branch contributed to the fibular periosteal blood supply. The most reliably found skin branch was located within 2 cm of the fibula midpoint. These findings reinforce the fact that a large skin island supplied by branches of the peroneal artery can be harvested with the fibula flap, and that the most reliable cutaneous vessels are found in the lower two-thirds of the leg, run posterior to the fibula in the posterior crural septum, and are always associated with muscular side branches.

Fibula↗

PubMed1992

[Vascularized fibula transfer. A review].

The first vascularized fibula transfer was done by Ueba et al. (1983) in 1974 and has since become a standard technique for special indications in the English, French, Japanese and Chinese-world. Within the last 5 years this technique has received more and more attention in the German-speaking countries. The vascularized fibula transfer is successfully used to reconstruct segmental bone defects larger than 5 to 8 cm that are caused by trauma, tumor, pseudarthrosis or congenital defects. When used to treat osteomyelitis, the vascularized fibula transfer failed to fulfill expectations. Bone defects smaller than 10 cm can also be treated by vascularized iliac crest transfer. To achieve rapid healing, the following points must be followed carefully: when treating osteomyelitis, the infection must be healed--negative cultures and good granulation tissue--prior to bone transplantation. Application of systemic or local antibiotics and aggressive debridement of necrotic bone and soft tissue must be carried out until the cultures taken from the wound are negative. Soft tissue defects must be treated by soft tissue transfer in order to facilitate wound closure with well-vascularized tissue. Vascularized bone transfer should be the treatment of choice for the femur and upper extremities. Precise preoperative planning, especially in high-energy trauma cases, reduces the complication rate. Rigid internal fixation of the bone graft with the recipient site by a smaller proximal and distal plate or by a plate bridging the whole bone defect running parallel to the fibula graft leads to rapid healing without malalignment.(ABSTRACT TRUNCATED AT 250 WORDS)

Bone Neoplasms↗

PubMed1992

[Mandibular reconstruction by free transfer of the fibula after cancer excision].

The authors present five cases of mandibular reconstruction using a vascularised fibula free transfer in cases of mandibulectomy for cancer. After giving a short account on the anatomy, they describe the technical details of fibula preparation and its transfer at the recipient site. The clinical observations are described. This recent technique seems to be developing, taking in account the qualities of the fibula: available bone length, possibility of performing osteotomies with preservation of the vascular supply, low morbidity at the level of the donor site, and satisfactory cosmetic and functional results. Despite of one recent failure, this short series seems to confirm the great interest in this type of bone reconstruction.

Adult↗

PubMed1992

[Free composite flaps with the fibula and their adaptation to mandibular reconstructive surgery. Apropos of 9 cases].

Although revascularized fibula bone transfers have been used in reconstructive surgery of long bones for about fifteen years, the first reported cases of mandibular reconstruction were only published in 1989 by Hidalgo. The mandible and the fibula actually have very few points in common apart from their respective length and a certain similarity of cross-section. However, free composite flaps including the fibula are adapted to reconstruction of the mandible for several reasons: the length of the bone which can be raised (25 cm) and osteotomized into several fragments; the addition of other components (skin, aponeurosis, muscle, etc.) for skin and/or mucosal repair; the spatial independence of these various elements; the microsurgical qualities of the peroneal artery. This possibility of multidirectional and multiple tissue bony mandibular reconstruction is analysed on the basis of 9 clinical cases: 5 cases of traumatic sequelae of the lower third of the face following gunshot injuries, 2 cases of radiation osteonecrosis, 2 benign bone diseases. The triple bone, integument and vascular adaptation between the fibular donor site and the recipient site must be assessed preoperatively. Due to the quality of the morphological and functional results compared with the limitations of other free composite bone transplants, the authors propose free composite fibular flaps as adapted and adaptable solutions for one-stage reconstruction of extensive mandibular defects (> 10 cm) associated with small or large mucocutaneous lesions.

Adult↗

PubMed1992

Free vascularized fibula grafting for the treatment of osteonecrosis of the femoral head.

A variety of joint-preserving operations have been devised to preserve the necrotic femoral head with varying success. Since 1979, the authors studied the effectiveness of vascularized fibula grafting in the treatment of osteonecrosis of the femoral head (ONFH) for joint preservation. Eighty-one of 121 hips with a minimum follow-up period ranged from three years to ten years eight months (mean, five years two months). All patients were evaluated clinically and roentgenographically on the basis of the causes and the stages of the disease. In the clinical assessment, 60 (74%) of 81 hips were rated excellent, 14 (17%) were rated good, six (7%) were rated fair, and one (2%) was rated poor. Overall satisfactory results, including excellent and good, were seen in 74 hips (91%). In the roentgenographic assessment, 57 hips (71%) had improved radiologically, 15 (18%) were unchanged, and nine (11%) were worse. Seventy-two hips (89%) showed roentgenographic improvement or unchange. Roentgenographic results had no significant correlation with the etiologic factors. Vascularized fibula grafting is one of the better alternatives for treating ONFH. It is highly expected that vascularized fibula grafting can prevent the necrotic femoral head from progressing to collapse and promote directly restored vascularization and new bone formation.

Adult↗

PubMed1978

["Fibula-pro-tibia-fusion" (Hahn-Brandes-Graft) in treatment of bone defects of the tibia (author's transl)].

The authors use the "fibula-pro-tibia fusion" (also called Hahn-Brandes Graft, for the treating large bone defects of the tibia shaft. This method is preferred both with congenital partial tibial aplasias with acquired extensive pseudarthrosis defects of the tibia. In congenital cases, grafting of the distal end of the fibula onto the calcaneal end of the foot with careful preservation of the epiphyseal disc, should precede surgery. Large differences in leg length can be treated after fusion surgery by means of elongation osteotomies. Attention is drawn to this method in the second example of pseudarthrosis defect. Lastly the authors mention a further method for mediation of large diaphyseal tibia defects, namely the transplantation of the opposing fibula. This can lead to good results when an aggressive form of fibrous dysplasia is not present, as was the case however in the third example. In such a case the process only heals after removal of the cover of the periosteum as well.

Adult↗

PubMed1977

Hypoplasia of the fibula.

Fibular hypoplasia occurs in differing degrees of severity with fibular hemimelia as its most severe form. Normally the distal epiphyseal plate of the fibula is at the same level as the distal end of the distal tibial epiphysis, whereas the tip of the proximal fibular epiphysis is level with the proximal tibial epiphyseal plate. Varying degrees of shortening of the fibula in relation to the tibia were found in 14 children, 6 of them boys. Shortening at the distal end of the tibia leads to instability of the ankle. Shortening at the proximal end of the fibula leads to hypoplasia of the lateral tibial plateau and valgus deformity of the knee. Syme type ankle disarticulation became necessary in five cases of fibular hemimelia because of leg length discrepancies or ankle instability.

Ankle Joint↗

PubMed1976

[Supporting role of the fibula in tibial fractures].

The possibilities of the supporting effect of the fibula and of its preclusion are discussed. The indication of the fibulotomia is dealt with. According to the authors' standpoint in the case of the anatomical reposition of the tibial fracture and after its staple synthesis the supporting effect of the fibula is not be be feared. In these cases the reposition and the osteosynthesis of the fibula neutralize fairly well also the motive forces acting on the tibial fracture.

Bone Nails↗

PubMed1979

Benign osteoblastoma of the fibula. Case report.

Report on a case of a patient, white, eleven years old, girl and brasilian, who came to the Service complaining of pain in both legs, at the level of the knee joint in a period of two years time. After an accurate orthopaedic examen the focal place was detected at the level of the proximal end of the fibula. The radiogram confirmed the existence of an osteolitic lesion in the superior end of the fibula, right side, in a cortical position and surrounded by a sclerotic area. The surgical removal was performed and the pathological examens confirmed to be a benign osteoblastoma. The postoperative evolution was normal and uneventfull. The radiograms demonstrate that in a three years period the healing of the bone was normal and total. No graft used and the periostal activity was the main source of bone formation.

Bone Neoplasms↗

PubMedDate not supplied

[Primary osteotomy of the fibula in the treatment of post-traumatic tibial pseudoarthrosis].

In a retrospective study 32 case histories of patients with primary osteotomies of the fibula were evaluated to find out the reliability of this method in the treatment of tibial pseudarthroses. The influence of the osteotomy level and extent was taken into account as well. In 23 cases the pseudarthroses resulted from tibial and fibular fractures. Causative for the pseudarthroses were the blocking effects of healed fibula, tibial infection and loose osteosynthetic materials. 22 tibial pseudoarthroses healed by fibular osteotomy and postoperative immobilisation only, healing time was 25 months on average, in case of proximal fibular osteotomies even longer. The extent of fibular resection was between 5 and 30 mm. In contrast to "modern" methods of treatment, primary osteotomies in the treatment of tibial pseudarthroses take a rather long time to heal.

Adult↗

PubMedDate not supplied

Congenital pseudarthrosis of the tibia: successful one stage transposition of the fibula into the distal tibia. A case report.

An infant male presented at age 17 months with an established pseudarthrosis in a kyphoscoliotic right tibia. During the ensuing 6 years, three unsuccessful McFarland bypass bone grafts were performed. Then the distal end of the proximal fibula was placed into the medullary cavity of the proximal end of the distal tibia without disturbing the proximal portion of the fibula. This was augmented by autogenous bone graft. Union occurred in one year. The child has been followed for 7 years and the pseudarthrosis remains healed.

Bone Diseases↗

PubMed1977

Irreducible fracture dislocation of the ankle due to posterior dislocation of the fibula.

In order to prevent permanent disability, a proper diagnosis of the fixed posterior fracture dislocation of the fibula with fracture dislocation of the ankle joint must be made. Full-length (knee to ankle) radiographs are necessary to make this diagnosis. Although a closed reduction has been described as successful, we feel that an open reduction is usually necessary. Freeing of the trapped fibula from behind the tibia results in a satisfactory reduction of this fracture dislocation. The reduction and fixation of the malleolar fragment is then simple, and an excellent result can be expected.

Adult↗

PubMed1977

A functional analysis of fusion of the tibia and fibula in the rat and mouse.

The distal diaphyseal shafts of the rat tibia and fibula fuse postnatally, a process initiated by the seventh day with the formation of secondary cartilage that is subsequently replaced by endochondral ossification. The histological appearance of this fusion process is described. A homologous process occurs postnatally in the mouse. An analysis of some of the pertinent recent developmental, comparative and paleontological data indicated that extrinsic, biomechanical factors probably played a significant causal role in tibia-fibula fusions. The production of secondary cartilage is evoked by extrinsic forces, and these fusions were analyzed within the present concepts of intrinsic and extrinisic factors in skeletogenesis. It was concluded that the fusions currently reported fit well within the hypothesis of the functional matrix and that, such fusions between skeletal tissues are secondary, compensatory and mechanically obligatory responses to the prior demands of functionally related nonskeletal tissues and organs.

Animals↗

PubMed1979

Congenital deficiency of the fibula.

Ninety-seven limbs, in eighty-one patients, with a diagnosis of congenital deficiency of the fibula have been reviewed. A classification was devised to distinguish the minimal hypoplasia of the fibula (Type I) from the well-known complete absence (Type II). Congenital anomalies of the femur were present in 76 per cent of patients with Type I deficiency and in 59 per cent with Type II. The shortening of the limb was by 13 per cent in Type I and by 19 per cent in Type II, and the percentage shortening was fairly constant during growth. A detailed description of the spectrum of other congenital anomalies was found to be characteristic: for example, the ball and socket formation of the ankle, tarsal coalition and anomalies of the foot. The treatment aimed simply to equalise leg length in Type I deficiency, while amputation of the foot and the fitting of a prosthesis were necessary in Type II to obtain satisfactory function.

Amputation, Surgical↗

PubMed1979

Fractures of the fibula at the distal tibiofibular syndesmosis.

Two basic fracture types are found at the level of the syndesmosis, supination-external rotation (SE) and pronation-abduction (PA), reflecting the mechanism of injury. The SE-type fracture of the fibula extends from the anterior edge in a posterosuperior direction, and the PA-type fracture extends from the medial surface either transversely or obliquely in a laterosuperior direction, and are often comminuted. The SE-types exist in 2 locations above and below the anterior fibular tubercle. All 3 types exist also in atypical forms. Treatment of the initial stages is by cast immobilization, and advanced lesions are treated by open reduction and internal fixation of the medial and lateral lesions of the ankle. The most common type of Wagstaffe fracture was type 2 which represents fractured anterior spike of the proximal fragment of the fibula.

Adolescent↗

PubMed1992

The osteocutaneous free fibula flap: is the skin paddle reliable?

This clinical and anatomic study was undertaken to see if the skin paddle of the osteocutaneous fibula flap could be made more reliable. Eighty cadaver limbs were dissected to evaluate the type, number, and location of the cutaneous perforators supplying the lateral leg. Three types of perforators were identified: septocutaneous, musculocutaneous, and a type we termed septomuscular, which does not actually run within the muscle substance but is adherent to the muscle. Although not a true musculocutaneous perforator, it should be treated as such clinically. Musculocutaneous perforators were found to be more numerous and more proximal than the septocutaneous perforators. Eighteen clinical cases demonstrate a 33 percent skin paddle survival when dissected as a septocutaneous flap and a 93 percent skin paddle survival when dissected as a septomusculocutaneous flap. In using the osteocutaneous fibula flap, it is recommended that a cuff of soleus and flexor hallucis longus be incorporated into the flap to help ensure flap viability.

Bone Transplantation↗