How effective is proximal fibular osteotomy in redistributing joint pressures? Insights from an HTO comparative in-silico study.

BACKGROUND: Knee osteoarthritis (KOA) represents a widespread degenerative condition among adults that significantly affects quality of life. This study aims to elucidate the biomechanical implications of proximal fibular osteotomy (PFO), a proposed cost-effective and straightforward intervention for KOA, comparing its effects against traditional high tibial osteotomy (HTO) through in-silico analysis. METHODS: Using medical imaging and finite element analysis (FEA), this research quantitatively evaluates the biomechanical outcomes of a simulated PFO procedure in patients with severe medial compartment genu-varum, who have undergone surgical correction with HTO. The study focused on evaluating changes in knee joint contact pressures, stress distribution, and anatomical positioning of the center of pressure (CoP). Three models are generated for each of the five patients investigated in this study, a preoperative original condition model, an in-silico PFO based on the same original condition data, and a reversed-engineered HTO in-silico model. RESULTS: The novel contribution of this investigation is the quantitative analysis of the impact of PFO on the biomechanics of the knee joint. The results provide mechanical evidence that PFO can effectively redistribute and homogenize joint stresses, while also repositioning the CoP towards the center of the knee, similar to what is observed post HTO. The findings propose PFO as a potentially viable and simpler alternative to conventional surgical methods for managing severe KOA, specifically in patients with medial compartment genu-varum. CONCLUSION: This research also marks the first application of FEA that may support one of the underlying biomechanical theories of PFO, providing a foundation for future clinical and in-silico studies.

Diaphyseal giant cell tumour of mid-shaft tibia.

SummaryGiant cell tumours of bone are benign and locally aggressive tumours that usually occur in young adults and at the epiphysial locations after physeal closure. Occurrence outside of epiphysial locations and appearance in geriatric patients is rare. We report a case of a woman in her late 60s with a giant cell tumour of the mid-shaft of the right tibia. Extended curettage and biological reconstruction were performed with autologous double-barrel fibular struts and tri-cortical iliac crest bone grafting. At the 28-month follow-up examination, we noted full bony union at both ends with successful consolidation of the fibular struts, and importantly, no evidence of recurrence or other complications was observed.

A newly designed anatomical plate for the therapy of posterolateral tibial plateau fracture via a supra-fibular-head approach: a retrospective study.

The posterolateral tibial plateau fracture is a special type of intra-articular fracture, for which there is no simple, safe, and effective standardized procedure. In this paper, we evaluate the clinical efficacy and the advantages of the treatment of posterolateral tibial plateau fracture by using our designed proximal lateral tibial rim plate for the posterolateral condyle of the tibial plateau via the space above the fibula head. Thirty-eight patients with posterolateral tibial plateau fractures from June 2018 to June 2021 were retrospectively analyzed. CT scans were used to classify the degree of injury in the included patients. All of them were fixed with reduction using an approach above the fibula head combined with a homemade anatomical plate. The regular postoperative review was performed to instruct functional knee exercises. Postoperative complications were observed and follow-up visits were performed to assess the functional outcome. A total of 38 patients with posterolateral tibial plateau fractures, 13 males and 25 females were included in the study. All patients were followed up for 13-26 months, with a mean of 15.3 months. There were no postoperative complications such as numbness of the limb, knee joint instability, etc. X-ray review showed that the fractures were all healed, and the healing time was 10-16 weeks, with an average of 12.1 weeks; none of the internal fixation loosening and loss of articular surface occurred during the follow-up period. At the last follow-up, according to the HSS knee function score criteria, the scores were 79-98, with an average of 91.3. The HSS score presented excellent in 34 cases (89%) and good in 4 cases (11%). The Rasmussen score was graded as excellent in 29 cases (76%) and good in 9 cases (24%). In conclusion, The treatment of posterolateral tibial plateau fractures by an approach above the fibula head has the advantages of simplicity and safety, small trauma, and no risk of vascular and nerve injuries, and the anatomical proximal lateral tibial rim plate can play a direct and effective supporting role for the bone fragments of the posterolateral condyle, and the combination of both of them has obvious advantages in the treatment of posterolateral condylar fracture of the tibial plateau, and it is a method worth borrowing and popularizing.

Gait asymmetries after fibular free flap harvest: A cross-sectional observational study.

BACKGROUND: The ability to walk safely after head and neck reconstruction with fibular free flaps in tumor surgery is a high priority for patients. In addition, surgeons and patients require objective knowledge of the functional donor-site morbidity. However, the effects of fibular free flap surgery on gait asymmetries have only been studied for step length and stance duration. This study analyses whether patients who have undergone fibular free flap reconstruction have enduring gait asymmetries compared to age-matched controls. METHODS: Patients who underwent head and neck reconstruction with fibular free flaps between 2019 and 2023 were recruited, as well as age-matched controls. Participants walked on an instrumented treadmill at 3 km/h. The primary outcome measures were 22 gait asymmetry metrics. Secondary outcome measures were the associations of gait asymmetry with the length of the harvested fibula, and with the time after surgery. FINDINGS: Nine out of 13 recruited patients completed the full assessment without holding on to the handrail on the treadmill. In addition, nine age-matched controls were enrolled. Twenty out of the 22 gait asymmetry parameters of patients were similar to healthy controls, while push-off peak force (p = 0.008) and medial impulse differed (p = 0.003). Gait asymmetry did not correlate with the length of the fibula harvested. Seven gait asymmetry parameters had a strong correlation with the time after surgery. INTERPRETATION: On the long-term, fibular free flap reconstruction has only a limited effect on the asymmetry of force-related and temporal gait parameters while walking on a treadmill.

[Comparative study of minimally invasive titanium elastic nail and steel plate on the treatment of fracture of tibiofibular fracture in adults].

OBJECTIVE: To compare the clinical outcomes of using elastic intramedullary nail and plate to fix fibular fracture. METHODS: The 60 patients with tibiofibular fractures admitted from January 2015 to December 2022 were divided into two groups:intramedullary nail group and plate group, 30 cases each, intramedullary nail group was treated with elastic intramedullary nail fixation group, plate group was treated with steel plate and screw fixation group. Intramedullary nail group, there were 18 males and 12 females, aged from 22 to 75 years old with an average of (39.4±9.8) years old, including 24 cases of traffic accidents injury, 6 cases of falling injury, 23 cases of closed fractures, 7 cases of open fractures. Steel plate group, there were 15 males and 15 females, aged from 24 to 78 years old with an average of (38.6±10.2) years old. The 22 cases were injured by traffic accident, 8 cases were injured by falling. The 24 cases were closed fractures and 6 cases were open fractures. The operation time, intraoperative bleeding, American Orthopedic Foot and Ankle Society (AOFAS) ankle and hind foot scores, clinical healing time of fibula and the incidence of wound complications were compared between the two groups. RESULTS: The patients in both groups were followed up for 6 to 21 months, with an average of (14.0±2.8) months. Compared with plate group, intramedullary nail group had shorter operative time, less bleeding, shorter clinical healing time of fibula, and lower infection rate of incision, and the difference was statistically significant (P<0.05). There were 2 cases of delayed healing in intramedullary nail group, 1 case of nonunion in plate group, and 2 cases of delayed healing in plate group, and there was no statistically significant difference between the two groups (P>0.05). In the last follow-up, according to the AOFAS scoring standard, the ankle function in intramedullary nail group was excellent in 17 cases, good in 12 cases, fair in 1 case, with an average of (88.33±4.57) points, while in plate group, excellent in 16 cases, good in 10 cases, fair in 4 cases, with an average of (87.00±4.14) points;There was no statistical difference between the two groups (P>0.05). CONCLUSION: Elastic intramedullary nail has the advantages of short operation time, less intraoperative bleeding, short fracture healing time and less incision complications in the treatment of fibular fracture, which is worthy of clinical application.

Alternative Treatment of Gonarthrosis: Proximal Fibular Osteotomy.

INTRODUCTION: Gonarthrosis is arthrosis of the knee joint, a chronic non-inflammatory disease manifested by progressive destruction of the intra-articular cartilage, accompanied by abnormal formation of the bones form the joint, changes in the synovial membrane and synovial fluid. Gonarthrosis is the most common type of arthrosis. Gonarthrosis can be treated conservatively and operatively. Among well-established surgical options for the treatment of medial gonarthrosis are high tibial osteotomy (HTO), unicompart-mental knee arthroplasty (UKA), and total knee arthroplasty (TKA). Proximal fibular osteotomy (PFO) or superior partial fibulectomy is a relatively recent procedure proposed to reduce knee pain in patients with medial compartment. AIM: Our study aims to demonstrate an alternative treatment for gonarthrosis with proximal fibular osteotomy and reduced knee pain in patients with medial compartment osteoarthritis of the knee. MATERIALS AND METHODS: At the Department of Orthopedics and Traumatology at J.Z.U "Borka Taleski" Prilep in the period from 2018 to 2021, 14 cases were treated, of which 11 were female and 3 were male. All patients were aged between 62 and 82 years with a mean age of 71.3 years. Patients had a severe degree of gonarthrosis (III/IV) according to Kellgren-Lawrence classification. Arthroscopy was performed in 2 patients. The fibula osteotomy was 7 cm away from the fibular head, with 1 cm resected bone fragment from the fibula. RESULTS: The average duration of the surgery was 30 minutes. Patients were followed up on the 7th day, first month, 3 months and 6 months after surgery. The final evaluation of function was done after 6 months by examining the active and passive movements of the knee joint. In all 14 patients we have excellent results with pain reduction, improvement of movement and quality of life. CONCLUSION: Proximal fibular osteotomy is an option for medial compartment osteoarthritis of the knee. Current literature is limited to small case series which report good outcomes in pain reduction, including the correction of varus deformity in medial gonarthrosis. Further studies are needed to determine the place of the PFO in the medial gonarthrosis management algorithm before it can be recommended for routine clinical use.

Are extra locking bolts or fibular plating more important in extreme nailing of distal tibia fractures? A cadaveric biomechanical analysis.

OBJECTIVES: In far-distal extra-articular tibia fracture "extreme" nailing, debate surrounds the relative biomechanical performance of plating the fibula compared with extra distal interlocks. This study aimed to evaluate several constructs for extreme nailing including one interlock (one medial-lateral interlock), one interlock + plate (one medial-lateral interlock with lateral fibula compression plating), and two interlocks (one medial-lateral interlock and one anterior-posterior interlock). METHODS: Fifteen pairs of fresh cadaver legs were instrumented with a tibial nail to the physeal scar. A 1 cm segment of bone was resected from the distal tibia 3.5 cm from the joint and an oblique osteotomy was made in the distal fibula. We loaded specimens with three different distal fixation constructs (one interlock, one interlock + plate, and two interlocks) through 10,000 cycles form 100N-700 N of axial loading. Load to failure (Newtons), angulation and displacement were also measured. RESULTS: Mean load to failure was 2092 N (one interlock), 1917 N (one interlock + plate), and 2545 N (two interlocks). Linear mixed effects modeling demonstrated that two interlocks had a load to failure 578 N higher than one interlock alone (95 % CI, 74N-1082 N; P = 0.02), but demonstrated no significant difference between one interlock and one interlock + plate. No statistically significant difference in rates or timing of displacement >2 mm or angulation >10° were demonstrated. CONCLUSIONS: When nailing far-distal extra-articular tibia and fibula fractures, adding a second interlock provides more stability than adding a fibular plate. Distal fibula plating may have minimal biomechanical effect in extreme nailing.

Free Vascularized Proximal Fibular Epiphyseal Transfer For Hip Reconstruction Following Septic Necrosis In Children.

BACKGROUND: Septic necrosis of the femoral head and neck in children represents a challenging problem. Several reconstructive techniques have been described but with disappointing long-term results. Vascularized epiphyseal transfer utilizing the proximal fibula have been successfully used for reconstruction of the proximal humerus and distal radius and only scarcely used for hip reconstruction. This cohort represents the largest reported series of epiphyseal transfer for hip reconstruction following septic necrosis in children. METHODS: A total of 18 patients with an average age at surgery of 5.4 years were included. The average follow-up was 3.6 years (range 2.3 to 6.8 y). RESULTS: Transient postoperative foot drop was observed in 4 patients. Radiographic resorption of the transferred fibula occurred in 2 cases. Longitudinal growth averaged 7.3 mm/year, and the physis width increased by an average of 2.7 mm/year. The rate of longitudinal growth was fastest after the age of 10 years (18.5 mm/y), which coincides with the pubertal growth spurt. All successful transfers had an open growth plate on final follow-up radiographs. Ten patients had limb length discrepancy of an average 2.8 cm (range 1 to 8 cm). Thirteen patients had satisfactory functional according to the criteria of Hunka et al. Three patients had unsatisfactory results; one had painful nonunion at the fibula-femur junction, and the other two had limited flexion range of 45 degrees. The average postoperative neck-shaft angle was 96.4 degrees which decreased by an average of 8 degrees at the final follow-up. Three patients underwent a valgus subtrochanteric osteotomy to correct a severe varus deformity. The final neck-shaft angle correlated significantly with the functional results where it averaged 96 degrees in the satisfactory group and 57 degrees in the unsatisfactory group. CONCLUSION: Vascularized epiphyseal transfer presents a promising treatment for children with septic necrosis of the femoral head and neck in whom other methods have failed to provide satisfactory long-term results. We recommend the procedure be done before the age of 5 years for optimum results. LEVEL OF EVIDENCE: Level-IV.

Functional and esthetic outcomes of virtual surgical planning versus the conventional technique in mandibular reconstruction with a free fibula flap: A retrospective study of 24 cases.

This study aimed to compare the functional and esthetic results in patients following mandibular reconstruction with a free fibula flap (FFF) by virtual surgical planning (VSP) versus the conventional technique. Patients who had undergone mandibular reconstruction with a FFF by VSP or the conventional technique were retrospectively assessed. The two groups were compared regarding functional and esthetic variables with appropriate scales preoperatively, intraoperatively, and postoperatively. Twenty-four patients were evaluated in two groups: conventional (n = 8) and VSP (n = 16). The mean amount of mandibular asymmetry was 2.62 mm (SD = 1.59) in the conventional group and 1.19 mm (SD = 1.32) in the VSP group. Of the patients who underwent conventional surgery, 12.5% had mandibular asymmetry of <2 mm and 87.5% had asymmetry of 2-5 mm. Of the VSP patients, 61.5% had mandibular asymmetry of <2 mm and 38.5% had mandibular asymmetry of 2-5 mm (p = 0.03). The mean difference in size of mandibular angle on the surgical and control sides was not significantly different between the two groups (p = 0.62). The difference in mean length of the mandibular body on the surgical side relative to the control side was not significant between the two groups (p = 0.75). Differences in functional variables between the two groups were not significant. Within the limitation of the study, it seems that the VSP technique resulted in better facial symmetry and superior esthetic outcomes compared with the conventional technique.

Use of the spider limb positioner for fibular free flap reconstruction of head and neck bony defects.

BACKGROUND: Osseous and osteocutaneous fibular free flaps are the workhorse of maxillomandibular reconstruction over 30 years after the initial description. Since 2019, we have routinely used the Spider Limb Positioner, adapted from its use in shoulder orthopedic procedures, for fibular free flap harvest. Herein, we describe this novel technique in our cohort. METHODS: We describe our intraoperative setup and endorse the versatility and utility of this technique in comparison to other reported fibular free flap harvest techniques. RESULTS: The Spider Limb Positioner was used 61 times in 60 different patients to harvest osseous or osteocutaneous fibular free flaps. Median (range) tourniquet time for flap harvest was 90 (40-124) minutes. No iatrogenic nerve compression injuries or complications related to lower extremity positioning occurred. CONCLUSION: We describe a novel approach to fibular free flap harvest utilizing the Spider Limb Positioner, which affords optimal ergonomics, visibility, and patient repositioning. There were no nerve injuries or complications related to positioning in our series.

Fibular morphology is not associated with incidence of peroneal tendon dislocation.

PURPOSE: The association of peroneal tendon dislocation with peroneal bone morphology and postoperative redislocation rates remains unknown. This study compared the fibula morphology in patients with peroneal tendon dislocation with that in a control population. METHODS: The study enrolled 48 patients who underwent surgery for peroneal tendon dislocation at our institution during between 2018 and 2023. Thirty-five patients with preoperative magnetic resonance imaging of the ankle were defined as Group D and 35 with magnetic resonance imaging of the ankle for other reasons and with similar background data were selected as the control group (Group C). The posterior tilting angle of the fibula, posterolateral angle and posterolateral edge angle were evaluated at the plafond level. The posterior tilting angle, posterolateral angle and retromalleolar bone shape according to the Rosenberg classification (flat, convex, concave) were evaluated at the midpoint between the plafond and the tip. RESULTS: At the plafond level, the posterior tilting, posterolateral and posterolateral edge angles were 57.7 ± 11.1°, 123.8 ± 12.3° and 90.8 ± 13.7°, respectively, in Group D and 64.1 ± 15.4°, 121.1 ± 12.3° and 88.7 ± 12.2°, respectively, in Group C, with no significant differences. No significant between-group differences existed in the posterior tilting and posterolateral angles at the midpoint level. Moreover, no significant differences existed in distribution of the bone geometry according to the Rosenberg classification. CONCLUSION: There were no differences in morphology between patients with peroneal tendon dislocation and controls. This study provides useful information on the indications for primary surgery and whether bony approach is useful for peroneal tendon dislocation. LEVEL OF EVIDENCE: Level IV.

An imageology-based feasibility study of plating posterolateral tibial plateau fractures via an anterolateral trans-fibular-head approach.

BACKGROUND: There are many difficulties in the reduction and fixation of the tibial plateau fractures involving posterolateral quadrant using general plates via traditional approaches. By imaging the area above the fibulae capitulum, this study was performed to investigate the feasibility of the trans-fibular-head approach and to design an ideal anatomical plate. METHODS: MRI and CT scans of the knee joint were collected from 205 healthy volunteers (103 males, 102 females). Gender and height were used to divide the volunteers into groups separately: (1) A1 group and A2 group according to gender, (2) B1 group and B2 group according to height. Based on the images, several parameters were defined and measured to describe the space above the head of the fibula. In addition, differences in these parameters between genders and height were compared. RESULTS: The narrowest distance in the bony region was (10.96 ± 1.39) mm, (5.41 ± 0.97 mm) in the bone-ligament region. The narrowest distance of bony region in the A1 group was more than that in the A2 group (11.21 ± 1.62 mm, 10.85 ± 1.47 mm, p = 0.029). The narrowest distance of the bony region was (10.21 ± 1.42) mm and (11.65 ± 1.39) mm in the B1 group and B2 group, respectively (p = 0.002). The narrowest distance of the bone-ligament region was (5.39 ± 0.78) mm and (5.22 ± 1.21) mm in the A1 group and A2 group, respectively. No statistically significant differences were observed between the A1 group and the A2 group in terms of the narrowest distance of the bone-ligament region. In the B1 group, the narrowest distance of the bone-ligament region (5.18 ± 0.71 mm) was not significantly less than that (5.31 ± 0.91 mm) in the B2 group. CONCLUSION: The space above the fibular capitellum was ample enough to place the plate for treating tibial plateau fractures involving posterolateral quadrant. The divisions of the lateral tibial plateau by 3-dimensional CT and the parameters of each region were crucial for providing guidance for designing the anatomical plate for the trans-fibular-head approach.

Surgical stabilization of a distal tibial fracture in a jungle cat (Felis chaus) using orthogonal double plating.

The jungle cat (Felis chaus) is a member of the genus Felis within the family Felidae, native to south-east Asia, west Asia and north Africa. A 2-year-old male jungle cat was referred with a history of lameness of 3 days duration. At the time of presentation, the animal had non-weight-bearing lameness of the right hindlimb. Examination identified crepitation and instability in the distal diaphyseal region of the right tibial bone. Radiographs confirmed the presence of fractures in the distal diaphyseal region of the right tibia and fibula. Double plating of the tibia was employed for used fixation. The animal was evaluated 2, 4 and 8 weeks post-operatively, and the procedure was considered to have been successful with no observed surgical complications.

[Clinical analysis of denture rehabilitation after mandibular fibula free-flap reconstruction].

OBJECTIVE: To evaluate the postoperative denture restoration and denture function in patients with mandibular defect reconstructed with vascularized free fibula flap. METHODS: In the study, 154 patients who underwent mandibular segment resection and used vascularized free fibula flap to repair mandibular defects due to inflammation, trauma and tumor from January 2015 to December 2020 were collected. These patients had common inclusion criteria which were stable occlusal relationship before operation, segmental defects of mandibular bone caused by lesions of mandible and adjacent parts (such as floor of mouth, tongue, cheek), free fibula flap used for repair and surviving after operation. Relevant data were reviewed and situation of denture restoration was followed up. A questionnaire related to denture functional evaluation had been proposed for those who had completed the denture rehabilitation. The evaluation index of denture restoration function was assigned by expert authority to obtain the denture function score. SPSS 18.0 software was used for statistical analysis of the basic information of the patients included in the study and the denture restoration of the patients. RESULTS: The rate of postoperative denture restoration in the patients with mandibular defects repaired by free fibula flap was 17.5%, and the rate of postoperative denture restoration in the patients with benign mandibular tumors was 25.0% (18/72), which was significantly greater than that in the patients with malignant tumors 11.0% (9/82, P < 0.05). There was no significant difference in denture function score between the patients with condylar defect and those without condylar defect in denture repair rate and denture function score (P>0.05). The functional score of implant denture was significantly greater than that of removable denture (P < 0.05). According to Brown classification, the denture function score of the patients with the defect invo-lving the anterior mandibular region was significantly greater than that of the patients without the anterior mandibular region involved (P < 0.05). The poor oral conditions, such as less amount of remaining teeth, insufficient retention strength, large mobility of soft tissue in the surgical area, poor oral vestibular groove condition became the main reason of not receiving denture restoration (37.86%). CONCLUSION: The denture rehabilitation of mandibular defect reconstructed with vascularized free fibula flap is closely rela-ted to pathological properties and oral conditions. The clinical outcome of implant denture has been confirmed effectively and it is a better choice for future denture restoration after mandibular reconstruction.

[Evaluation of lower limb function and gait characteristics after fibulectomy in adults].

Objective: To explore the effects of fibulectomy on lower limb function and gait of adult patients through gait analysis, in order to provide guidance for clinical treatment. Methods: A clinical data of 24 patients who underwent fibulectomy and met the selection criteria between January 2017 and December 2022 was retrospectively analyzed. There were 12 males and 12 females with an average age of 25 years (range, 18-68 years). The length of fibulectomy was 10-19 cm, with an average of 15 cm. The patients underwent routine rehabilitation training after operation. The occurrence of postoperative complications was recorded, the pain degree of surgical incision was evaluated by visual analogue scale (VAS) score, and the residual fibular bone was reviewed by imaging. A gait test system was used before operation and at 6 months after operation to collect gait data of healthy and affected sides under slow, medium, and fast velocity conditions, including gait parameters (foot rotation angle, step length, support phase, swing phase, gait line length, single support line, maximum force 1, maximum force 2) and the tripod area parameters (maximum pressure, time maximum force, and contact time of forefoot, midfoot, and hindfoot). Results: All incisions healed by first intention after operation. All patients were followed up 1-5 years, with an average of 3 years. The great dorso-extension muscle strength decreased in 3 cases, and the sensory defects in the operative area and distal part occurred in 5 cases. The VAS scores of incisions were 0-6 (mean, 4) at 6 months after operation and 0-5 (mean, 2) at last follow-up. During follow-up, imaging review showed that 5 cases had osteoporotic changes of distal residual bone of the fibula, and the residual segment was shorter and more significant; 3 cases had new bone formation. The results of gait test showed that the gait parameters and the tripod area parameters under the three gait speeds were consistent. There was no significant difference in the gait parameters and the tripod area parameters between the healthy side and the affected side before operation ( P>0.05). Compared with the healthy side, the foot rotation angle, the single support line, the maximum force 1, the maximum force 2, and the maximum pressures of the forefoot and midfoot of the affected side significantly decreased after operation ( P<0.05), and the step length, the time maximum force of midfoot and hindfoot, and the contact time of the forefoot and midfoot significantly increased ( P<0.05). Compared with preoperative conditions on the same side, the foot rotation angle, the gait line length of both sides significantly decreased ( P<0.05), and the maximum pressures of the forefoot, midfoot, and hindfoot and the time maximum force of the midfoot significantly increased ( P<0.05); the step length on healthy side significantly decreased, while the affected side significantly increased ( P<0.05); the maximum force 1 and the maximum force 2 on the healthy side significantly increased, while the affected side significantly decreased ( P<0.05); the single support line on the affected side significantly decreased ( P<0.05). Conclusion: Different degrees of clinical symptoms occurred, gait pattern changes, compensatory gait appears, gait stability decreases, and the risk of tumble increases in adult patients after partial fibulectomy. Therefore, it is recommended to walk slowly after fibulectomy.

Impact of virtual surgical planning and three-dimensional modeling on time to surgery in mandibular reconstruction by free fibula flap.

PURPOSE: Mandible reconstruction using a free fibula flap (FFF) is preferably performed with virtual surgical planning (VSP) to potentially improve functional and aesthetic outcomes. However, VSP is time-consuming. This study aims to assess the impact of VSP on time to surgery (TS). MATERIALS AND METHODS: All patients who underwent FFF for oral cavity cancer between 2007 and 2020 were included. Time to surgery (from the date of the first consultation to the surgery date) was compared between patients without VSP and with VSP. In our department, VSP and 3D modeling were performed by an external engineering laboratory. RESULTS: One hundred sixty-five patients were included retrospectively. VSP was utilized for 90 patients (55%). The mean time to surgery was 31 ± 16 days for patients undergoing conventional surgery without VSP and 44 ± 19 days for patients with VSP (p < 0.001). No clinical or tumoral characteristic were associated with a TS extended, except for the utilization of VSP (p < 0.001). By constituting groups of 25 consecutive patients, there is no difference in TS between the groups. CONCLUSION: The use of VSP significantly increased the time to surgery in our study, unrelated to clinical differences or year of surgery. This delay may have an impact on oncologic outcomes, so it should be considered in the care organization for each patient. Implementing new procedures to reduce this difference is warranted.

Outcomes of Lateral Transfibular Approach for Total Ankle Replacement.

Total ankle replacement through a lateral transfibular approach with trabecular metal implants was introduced in 2012 and originally was advertised as a safer approach in terms of wound healing issues. Further studies showed no significant difference comparing anterior and lateral approach for infections and would healing issues, whereas the main advantage is deformity correction, acting on coronal, sagittal, and rotational deformities and on fibular length issues. It showed a survival rate of 97.7% at 5 years follow-up.

Immediate Teeth in Fibulas Versus Standard Fibula Free Flap: A Comparison of Donor Surgical Site Infections.

BACKGROUND: Immediate placement of dental implants with dental restoration at the leg donor site requires implant components and prosthetic materials that are not packaged sterile. PURPOSE: This study aimed to determine if there was a difference in donor surgical site infection between patients that received a fibula free flap with dental implants and immediate teeth (ITFFF: immediate teeth fibula free flap) before flap transfer to the defect site when compared to standard fibula free flaps (SFFFs) without dental implant placement. STUDY DESIGN, SETTING, SAMPLE: A retrospective cohort study was designed and implemented. The study population was composed of patients who underwent free fibula flap transfer for the treatment of benign or malignant conditions of the head and neck from 2015 to 2022. Patients who received immediate dental implants without teeth were excluded, since those implants are sterile and buried under soft tissue. PREDICTOR VARIABLE: The surgical treatment with either ITFFF or SFFF was treated as the primary predictor variable. MAIN OUTCOME VARIABLE: The primary outcome variable was postoperative donor surgical site infection. COVARIATES: There were 12 covariate variables including age, sex, diabetes diagnosis, immunosuppression/prior chemotherapy treatment, body mass index, smoking status, pack year history, pathology treated, technique for fibula donor site closure, skin paddle harvest, skin paddle area (cm2), and negative pressure wound therapy. ANALYSES: For the effect of the covariates on the primary predictor variable, χ2 analyses and t-tests were used. The effect of the primary predictor variable on the primary outcome was evaluated using χ2 analysis. A P value of < 0.05 was considered statistically significant. RESULTS: There were 37 patients in the ITFFF group and 47 in the SFFF group. The donor site infection rate for the entire study population was 2.38%. In the ITFFF group, there was 1 donor surgical site infection (2.70%), and in the SFFF group there was also 1 donor surgical site infection (2.13%). There was no significant difference in donor surgical site infection between the groups (P = .86). CONCLUSION AND RELEVANCE: This study found no difference in donor surgical site infection rates between patients who received ITFFF versus SFFF. The overall donor surgical site infection rate following fibula free flap is low.

In-house virtual surgical planning and guided mandibular reconstruction is less precise, but more economical and time-efficient than commercial procedures.

BACKGROUND: To compare an in-house and a commercially available surgical planning solution for mandibular reconstruction in terms of postoperative reconstruction accuracy and economic benefit. METHODS: Twenty-nine consecutive patients with advanced oral squamous cell carcinoma (OSCC) requiring segmental mandibular reconstruction were enrolled. Fifteen patients underwent in-house surgical planning and 14 patients underwent a commercially available planning solution. A morphometric comparison of preoperative and postoperative computed tomography (CT) data sets and a cost-benefit comparison were performed. RESULTS: Volumes of planned and reconstructed bone segments differed significantly for both in-house planning (p = 0.0431) and commercial planning (p < 0.0001). Significant differences in osteotomy angles were demonstrated for in-house planning (p = 0.0391). Commercial planning was superior to in-house planning for total mandibular deviation (p = 0.0217), intersegmental space volumes (p = 0.0035), and lengths (p = 0.0007). No significant difference was found between the two planning solutions in terms of intersegmental ossification and the incidence of wound healing disorders. In-house planning took less time than commercial planning (p < 0.0001). Component manufacturing costs (p < 0.0001) and total cumulative costs (p < 0.0001) were significantly lower for in-house planning. CONCLUSIONS: In-house surgical planning is less accurate but has a cost advantage and could be performed in less time.