Application of modified anterolateral supra-fibular-head approach in treatment of tibial plateau fractures involving posterolateral column / 中国修复重建外科杂志

Objective: To explore effectiveness of reduction and internal fixation via modified anterolateral supra-fibular-head approach in treatment of tibial plateau fractures involving posterolateral column. Methods: Between January 2016 and September 2018, 19 patients diagnosed as tibial plateau fractures involving posterolateral column were treated with reduction and internal fixation via modified anterolateral supra-fibular-head approach. There were 11 males and 8 females with an average age of 43.2 years (range, 28-65 years). The causes of tibial fracture were traffic accident (12 patients), falling injury (5 patients), and falling from height (2 patients). According to the Schatzker typing, the tibial fractures were rated as type Ⅱ in 9 cases, type Ⅲ in 4 cases, type Ⅴ in 4 cases, and type Ⅵ in 2 cases. The time from injury to operation was 5-13 days (mean, 8.5 days). There were 2 patients with osteoporosis. The operation time, intraoperative blood loss, and postoperative complications were recorded. The knee X-ray film was reviewed regularly to observe the fracture healing. At last follow-up, the fracture reductions were evaluated by Rasmussen radiological score. The knee joint function was evaluated by Hospital for Special Surgery (HSS) score system. Results: The average operation time was 95 minutes (range, 65-130 minutes). The average intraoperative blood loss was 220 mL (range, 150-350 mL). All incisions healed by first intention. No complications such as infection or deep venous thrombosis occurred. All patients were followed up 12-20 months (mean, 15.4 months). X-ray films showed that the fractures healed with the healing time of 12-20 weeks (mean, 14.5 weeks). No complications such as loosening or breakage of internal fixation occurred. At last follow-up, according to the Rasmussen radiological score, the fracture reductions were evaluated as excellent in 13 cases, good in 4 cases, fair in 1 case, and poor in 1 case. HSS scores of knee joint function were excellent in 14 cases, good in 3 cases, fair in 1 case, and poor in 1 case. The knee joint range of motion was 90°-135°, with an average of 113.4°. Conclusion: Application of modified anterolateral supra-fibular-head approach in reduction and internal fixation for tibial plateau fractures involving posterolateral column has the advantages of full exposure, less trauma, safety, and reliable reduction and fixation.

Precision repairing of compound tissue defect at limbs by 3-Dimentional contrast printing and fibular head compound tissue flap transplantation / 中华显微外科杂志

Objective To explore the clinical application and effect of fibular head compound soft tissue flap transplantation on precision repairing of compound tissue defect at limb joints assisted by 3-Dimensional contrast printing technology.Methods From March,2014 to September,2017,9 patients with bone and soft tissue defect at limb joints were selected.In which,2 were distal radius bone defect with joint capsule and ligament defect,2 were lower segment tibia bone and soft tissue defect,2 were femur under section of the bone and soft tissue defect,2 were medial malleolus bone and ligament defect,and 1 was external ankle ligament and bone defect.Using 3-Dimensional printing to conduct bilateral mirror-image contrast prior to the operation,morphology of bone defect at limb joints was acquired.Based on the texture printed out,corresponding fibular head compound blocks with blood vessels were removed from the donor site and transplanted to the recipient site before anastomosing the blood vessels and restoring the blood flow.The regular post-operative followed-up was performed.Results The 9 transplanted tissue blocks survived.The donor sites and the recipient sites were healed.The followed-up for restoration of limb function was from 9 to 35 (average,17.5) months.The ankle function was assessed according Kofoed scale,resulted in 2 excellent and 1 good;The wrist function was assessed according Mayo scale,resulted in 1 excellent and 1 good.The medial malleolus bone defect and criteria bone defect were healed at 6 months.The patients were satisfied with the efficacy.Conclusion The application of 3-Dimensional contrast printing of fibular head compound tissue flap transplantation in repairing compound tissue defects at limb joints can reduce damage to the donor site,realizing precise repairing on limb tissue defect,and make good function restoration.

Combination of vascularized fibular head epiphysis and superficial peroneal neurovascular reverse flap repair defects of bone and skin in lateral malleolus in children / 中华显微外科杂志

Objective To explore the clinical effect of combination of vascularized fibular head epiphysis and peroneal neurovascular reverse flap repair defects of bone and skin in lateral malleolus in children.Methods Eight children with defects of bone and skin in lateral malleolus were recruited from May,2009 to September,2014.The age of children was ranging from 4 to 12 years old.Four children were injured by wheel twist,2 children were injured by traffic accident,1 was injured by machinery,and 1 was crashed with heavy object.The size of soft-tissue defect was ranging from 3 cm × 5 cm to 7 cm × 9 cm.The flap and bone healing along with ankle joint function scoring were evaluated.Patients were reviewed every 4 to 6 weeks during one year after their surgery,and they were reviewed every 6 months one year later.Results Secondary repair were conducted in all children.The curative effect got well after follow up for 6 months to 2 years(mean,12 months).The flap and fibular head epiphysis were well developed.The ossification of fibular head epiphysis did not found.According to American Orthopaedic Foot and Ankle Society (AOFAS) ankle function evaluation criteria,the results were excellent in 5 cases,good in 2 cases and poor in 1 at 10 months after operation.The shape and function of ankle joint were good,with one exception.The average motion degree of ankle joint was (68±5.12)°.Conclusion Combination of vascularized fibular head epiphysis and peroneal neurovascular reverse flap repair defects of bone and skin in lateral malleolus in children is effective.

Fibular head composite flap in repairing the bone and skin defect of radiocarpal joint / 中华整形外科杂志

Objective@#To investigate the therapeutic effect of fibular head composite flap in repairing the bone and skin defect of radiocarpal joint.@*Methods@#From Aug.2009 to Dec.2016, 9 cases with bone and skin defects at radiocarpal joint were reconstructed with fibular head composite flaps pedicled with lateral inferior genicular vascular bundle. The skin defect size was (3-7) cm×(5-10) cm.The joint function was assessed by the Gartland-Werley standard score.@*Results@#All 9 patients were followed up for 6 months to 3 years, with an average of 18 months.Primary wound healing was achieved in all cases without infection.Bony union of the transplanted fibular head was observed .The range of motion (ROM) of the wrist joint and forearm was assessed as following: the mean extension range of motion was 32.9° (range 29°-41°), flexion 24.5° (range 18°-33°), pronation 75° (range 56°-83°)and supination 65.4° (range 40°-78°). The average grip strength was 78% of that on the healthy side. Mayo wrist score was 85 on average, ranging from 58 to 91.By the Gartland-Werley standard score, the wrist function was rated as excellent in 3 case, good in 5 cases and fair in 1 case, with an excellent to good rate of 88.9%.All patients could cope with daily life and work, with good wrist stability and no motion-related pain.@*Conclusions@#The fibular head composite tissue flap has a good therapeutic effect in repairing the bone and skin defect of radiocarpal joint.

Several Considerations in Free Vascularized Fibular Head Grafting for Giant Cell Tumor of Distal Radius

Treatment of giant cell tumor of distal radius can be treated in several ways according to the aggressiveness of the tumor. The management of giant cell tumor involving subchondral bone of the distal radius has always been a difficult problem and whether preserving joint function should be considered. In these circumstances, wrist arthroplasty using free vascularized fibular head grafting can be considered as one of available options to preserve the wrist joint motion. However, the reports for final outcomes of wrist arthroplasty using vascularized fibular head have been variable and there have been several debates about its techniques. The purpose of this article is to discuss the several considerations in wrist arthroplasty using free vascularized fubular head graft for giant cell tumors of the distal radius.

A Case of Peroneal Nerve Palsy Secondary to Fibular Head Osteochondroma

Osteochondroma of the proximal fibula is relatively common, but there are only rare reports of this lesion in conjunction with peroneal nerve palsy. We report here on a case of the peroneal nerve palsy secondary to fibular head osteochondroma, and the patient experienced complete recovery of function following the excision of the tumor and neurolysis of the peroneal nerve.

Reconstruction of Wrist Joint Using Vascularized Free Fibular Head Graft After the Wide Tumor Excision of Distal Radius

Vascularized free fibula head transfer is an established method for reconstruction of long bone defects of the upper limb involving the distal radius or the proximal humerus. For the wrist following tumor resection, in cases of resection of the radial articular surface, three reconstructive options are possible: 1. fibular head transfer to replace the radial joint surface, 2. fixation of the fibula to the scaphoid and lunate, 3. complete wrist fusion. The decision on the type of the operation depends on the amount of the resection and the remained normal anatomical structures, and also the necessity of function of the wrist in the future. The authors believe that the vascularized free fibula head graft is a safe and reliable method for reconstructing the upper limb, especially for patients with a defect of the distal radius, and report the operative methods, donor vascular consideration, complications, and functional result after this operation.

Reference Value for the Cross Sectional Area of Fibular Nerve Ultrasonography through the Anatomic Investigation in Korean

OBJECTIVE: To investigate the reference value for cross sectional area (CSA) of the fibular nerve in Koreans. METHOD: One musculoskeletal radiologist and one physiatrist performed fibular nerve ultrasonography (US) on 60 lower extremities of 30 asymptomatic Korean volunteers (16 males, 14 females). The mean age was 46.6 years (range: 21-75 years). We measured CSA of the fibular nerve at three sites: proximal portion (PP) at the bifurcation, mid-portion (MP), and an area just above the fibular head (FH). In addition, the fibular nerves of 7 lower extremities from 4 cadavers were cut from the fibular head to the proximal portion and divided into three sections (PP, MP, FH). They were subsequently fixed with 10% neutral buffered formalin and perpendicularly excised to 2 mm thickness. They were photographed by an operating microscope and CSA was measured. Using the Kruskal-Wallis test, measurements obtained from US images were compared between asymptomatic volunteers with a significance level of 0.05. RESULTS: In asymptomatic volunteers, the CSA of the three portions were PP: 13.8+/-1.2 mm2, MP: 11.1+/-1.0 mm2, FH: 10.9+/-0.6 mm2. The fibular nerves were well visualized with clear borders by US. In cadavers, the CSA of three portions were PP: 20.3+/-10.3 mm2, MP: 16.7+/-8.6 mm2, FH: 14.4+/-8.9 mm2. There was no significant difference between the three portions in asymptomatic volunteers and cadavers (p>0.05). CONCLUSION: In normal Korean adults, the area of fibular nerve at the fibular head is 10.9+/-0.6 mm2. Ultrasonographic evaluation of the fibular nerve can be helpful in diagnosing fibular nerve lesions.

Applied anatomical and clinical application of reconstruction of the medial malleolus with bone-severed vascularized fibular head epiphysis / 中华显微外科杂志

Objective To provide an anatomical basis for repairing the medial malleolus with bone-severed vascularized fibular head epiphysis, and to explore the effect of clinical application with this method. Methods Figures of fibular head and medial malleolus were measured on 20 fresh lower limbs specimens of child age from 2 to 12 years old, then bone-severed formula was deduced. The bone-severed composite fibular head epiphysis to repair the defect of medial malleolus were carried for 6 child patients of emergency or post-poned cases on one stage. Obersved the clinical effect by following-up. Results The angle between fibular head and stem (M) was(170±8)°, angle of fibular head sadacc(N) was (145 ±6)°, length(1.5±0.2)cm and width (1.4±0.2)cm; angle between medial malleolus and stem(1) was(152±8)°, length of the articular surface of medial malholus was(1.25 ± 0.2)cm and width (1.25 ± 0.2)cm. Angle between defect surface and tibia was(Q). Formula: angle of bone-severing X = L-N-Q, and apex at the upper 1/6 of the reversed articular surface of fibular. 6 cases with this method was completed, all healed at stage one, following-up 1 to 3 years, medial malleolos developed well and no epiphysis ossification anticipation, and the ankle joint has no inversion with its loadind and walking function good. Conclusion The fibular head epiphysis and the medial malleolus differ in shape to some extent, but good donor can be got by bone-severing, can repair the epiphysis and soft tissue defect of the medial malleolus at one stage with additional flap, developing with the child at the same time, it is a perfect method to reconstruct the traumatic defect of child medial malleohs.

A Comparison of Fibular Head Tunnel and Tibial Tunnel in the Reconstruction of a Posterolateral Instability of the Knee / 대한정형외과학회잡지

PURPOSE: This study compared the surgical results of various posterolateral corner sling methods performed through either the fibula head tunnel or tibia tunnel in patients with chronic PLRI (PosteroLateral Rotatory Instability). MATERIALS AND METHODS: Between January 1999 and October 2003, 20 and 19 patients who had undergone surgery for PCL (posterior cruciate ligament) tensioning and an ALB (anterolateral bundle) reconstruction through the fibula head tunnel or tibia tunnel, respectively and were followed up more than 1 year were enrolled in this study. RESULTS: The fibular head tunnel was found to be superior compared with the tibia tunnel method in terms of the operation time (36.5+/-7.5 versus 68.4+/-12.8) (p<0.0001), rotational stability (p= 0.0018) and IKDC objective score (p<0.0001). In the fibula head tunnel group, 85% of patients had an equal to normal or tighter than normal rotational stability in the tibial tunnel group with 63% having an equal to normal or tighter than normal side at the last evaluation. In the IKDC objective score, 85% of patients in the fibula head tunnel group had a rating B or higher at the last evaluation compared with 79% in the tibial tunnel group (p<0.0001). However there were no significant differences in anteroposterior stability and OAK score. CONCLUSION: The modified posterolateral corner sling through the fibula head tunnel produces better results in terms of a posterolateral rotational stability of grade II chronic PLRL in a combined PCL injury than that using the tibia tunnel method.