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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. B shows nonunion of fibula osteotomy site with valgus deformity of the ankle, 2 years after surgery.
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Figure 3: A. An 11-year-old girl with achondroplasia. Preoperative standing. B shows nonunion of fibula osteotomy site with valgus deformity of the ankle, 2 years after surgery.

Mentions: Valgus of the knee (valgus change of MAD) increased with increased lengthening. PFM and the amount of lengthening were interrelated to some extent, even though it was not statistically significant (p = 0.08). PFM was associated with valgus deformity of the knee (p = 0.03). PFM and valgus change of MAD showed statistically significant differences depending on lengthening percentage (Table 1). Premature consolidation of the fibula resulted in complications around the knee with a significant increase in PFM, while nonunion of the fibula was associated with complications around the ankle with a significant increase in the DFM (Table 2 and Figure 3).


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. B shows nonunion of fibula osteotomy site with valgus deformity of the ankle, 2 years after surgery.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 3: A. An 11-year-old girl with achondroplasia. Preoperative standing. B shows nonunion of fibula osteotomy site with valgus deformity of the ankle, 2 years after surgery.
Mentions: Valgus of the knee (valgus change of MAD) increased with increased lengthening. PFM and the amount of lengthening were interrelated to some extent, even though it was not statistically significant (p = 0.08). PFM was associated with valgus deformity of the knee (p = 0.03). PFM and valgus change of MAD showed statistically significant differences depending on lengthening percentage (Table 1). Premature consolidation of the fibula resulted in complications around the knee with a significant increase in PFM, while nonunion of the fibula was associated with complications around the ankle with a significant increase in the DFM (Table 2 and Figure 3).

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