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Fibula-related complications during bilateral tibial lengthening: 60 patients followed for mean 5 years.

Kim SJ, Agashe MV, Song SH, Song HR - Acta Orthop (2012)

Bottom Line: Most published studies have analyzed only migration of the fibula during lengthening, with few studies examining the effects of fibular complications.PFM induced valgus deformity of the knee, and premature consolidation of the fibula was associated with the distal migration of the proximal fibula.Thus, during lengthening repeated radiographic examinations of the fibula are necessary to avoid complications.

View Article: PubMed Central - PubMed

Affiliation: Korea University Medical Center, Guro Hospital, Seoul, South Korea.

ABSTRACT

Background and purpose: Complications related to the fibula during distraction osteogenesis could cause malalignment. Most published studies have analyzed only migration of the fibula during lengthening, with few studies examining the effects of fibular complications.

Patients and methods: We retrospectively reviewed 120 segments (in 60 patients) between 2002 and 2009. All patients underwent bilateral tibial lengthening of more than 5 cm. The mean follow-up time was 4.9 (2.5-6.9) years.

Results: The average lengthening percentage was 34% (21-65). The ratio of mean fibular length to tibial length was 1.05 (0.91-1.11) preoperatively and 0.83 (0.65-0.95) postoperatively. The mean proximal fibular migration (PFM) was 15 (4-31) mm and mean distal fibular migration (DFM) was 9.7 (0-24) mm. Premature consolidation occurred in 10 segments, nonunion occurred in 12, and angulation of fibula occurred in 8 segments after lengthening. Valgus deformities of the knee occurred in 10 segments.

Interpretation: PFM induced valgus deformity of the knee, and premature consolidation of the fibula was associated with the distal migration of the proximal fibula. These mechanical malalignments could sometimes be serious enough to warrant surgical correction. Thus, during lengthening repeated radiographic examinations of the fibula are necessary to avoid complications.

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A. An 11-year-old girl with achondroplasia. Preoperative standing. The proximal line shows the level of the tip of the medial malleolus while the distal line denotes the level of the tip of the lateral malleolus. B. Proximal migration of the distal fibula with valgus deformity of the right ankle. Proximal migration of the distal fibula was measured by comparing the amount of the lateral malleolus projecting distal to the medial malleolus on preoperative and postoperative radiographs.
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Figure 2: A. An 11-year-old girl with achondroplasia. Preoperative standing. The proximal line shows the level of the tip of the medial malleolus while the distal line denotes the level of the tip of the lateral malleolus. B. Proximal migration of the distal fibula with valgus deformity of the right ankle. Proximal migration of the distal fibula was measured by comparing the amount of the lateral malleolus projecting distal to the medial malleolus on preoperative and postoperative radiographs.

Mentions: Fibula complications occurred in 30 of the 120 segments during lengthening. There were 10 segments with premature consolidation, 12 segments with nonunion, and 8 segments with angulation of the fibula. All patients showed PFM (Figure 1) and 96 segments showed DFM (Figure 2). Valgus deformity of the knee occurred in 10 segments, and the mean MAD of these 10 segments was 15 (12–20) mm of valgus. All patients with valgus deformity of the knee showed PFM of more than 10 mm. The mean angulation of the fibula was 5.1 (1.5–16) degrees at the final follow-up. Cut-out of the wire from the fibula occurred in 10 segments. There was only 1 segment with cut-out of the wire in patients who had lengthening of less than 25% and 9 segments with cut-out of the wire were in patients who had lengthening of more than 25%. Equinus contracture was the commonest complication with 20 segments. The mean equinus deformity was 14 (5–19) degrees after surgery and 4.2 (0–9) degrees after removal of the external fixator. Recession of gastrocnemius aponeurosis to correct equinus deformity was performed.


Fibula-related complications during bilateral tibial lengthening: 60 patients followed for mean 5 years.

Kim SJ, Agashe MV, Song SH, Song HR - Acta Orthop (2012)

A. An 11-year-old girl with achondroplasia. Preoperative standing. The proximal line shows the level of the tip of the medial malleolus while the distal line denotes the level of the tip of the lateral malleolus. B. Proximal migration of the distal fibula with valgus deformity of the right ankle. Proximal migration of the distal fibula was measured by comparing the amount of the lateral malleolus projecting distal to the medial malleolus on preoperative and postoperative radiographs.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3369154&req=5

Figure 2: A. An 11-year-old girl with achondroplasia. Preoperative standing. The proximal line shows the level of the tip of the medial malleolus while the distal line denotes the level of the tip of the lateral malleolus. B. Proximal migration of the distal fibula with valgus deformity of the right ankle. Proximal migration of the distal fibula was measured by comparing the amount of the lateral malleolus projecting distal to the medial malleolus on preoperative and postoperative radiographs.
Mentions: Fibula complications occurred in 30 of the 120 segments during lengthening. There were 10 segments with premature consolidation, 12 segments with nonunion, and 8 segments with angulation of the fibula. All patients showed PFM (Figure 1) and 96 segments showed DFM (Figure 2). Valgus deformity of the knee occurred in 10 segments, and the mean MAD of these 10 segments was 15 (12–20) mm of valgus. All patients with valgus deformity of the knee showed PFM of more than 10 mm. The mean angulation of the fibula was 5.1 (1.5–16) degrees at the final follow-up. Cut-out of the wire from the fibula occurred in 10 segments. There was only 1 segment with cut-out of the wire in patients who had lengthening of less than 25% and 9 segments with cut-out of the wire were in patients who had lengthening of more than 25%. Equinus contracture was the commonest complication with 20 segments. The mean equinus deformity was 14 (5–19) degrees after surgery and 4.2 (0–9) degrees after removal of the external fixator. Recession of gastrocnemius aponeurosis to correct equinus deformity was performed.

Bottom Line: Most published studies have analyzed only migration of the fibula during lengthening, with few studies examining the effects of fibular complications.PFM induced valgus deformity of the knee, and premature consolidation of the fibula was associated with the distal migration of the proximal fibula.Thus, during lengthening repeated radiographic examinations of the fibula are necessary to avoid complications.

View Article: PubMed Central - PubMed

Affiliation: Korea University Medical Center, Guro Hospital, Seoul, South Korea.

ABSTRACT

Background and purpose: Complications related to the fibula during distraction osteogenesis could cause malalignment. Most published studies have analyzed only migration of the fibula during lengthening, with few studies examining the effects of fibular complications.

Patients and methods: We retrospectively reviewed 120 segments (in 60 patients) between 2002 and 2009. All patients underwent bilateral tibial lengthening of more than 5 cm. The mean follow-up time was 4.9 (2.5-6.9) years.

Results: The average lengthening percentage was 34% (21-65). The ratio of mean fibular length to tibial length was 1.05 (0.91-1.11) preoperatively and 0.83 (0.65-0.95) postoperatively. The mean proximal fibular migration (PFM) was 15 (4-31) mm and mean distal fibular migration (DFM) was 9.7 (0-24) mm. Premature consolidation occurred in 10 segments, nonunion occurred in 12, and angulation of fibula occurred in 8 segments after lengthening. Valgus deformities of the knee occurred in 10 segments.

Interpretation: PFM induced valgus deformity of the knee, and premature consolidation of the fibula was associated with the distal migration of the proximal fibula. These mechanical malalignments could sometimes be serious enough to warrant surgical correction. Thus, during lengthening repeated radiographic examinations of the fibula are necessary to avoid complications.

Show MeSH
Related in: MedlinePlus