Download PDF
J Reconstr Microsurg 2002; 18(2): 091-096
DOI: 10.1055/s-2002-19888
Copyright © 2002 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA. Tel.: +1(212) 584-4662

Valgus Deformity of the Ankle Following Harvesting of a Vascularized Fibular Graft in Children

K. Kanaya1 , T. Wada1 , H. Kura1 , T. Yamashita1 , M. Usui2 , S. Ishii1
  • 1Department of Orthopedic Surgery Sapporo >Medical University Sapporo, Japan
  • 2Orthopedic Clinic Higashi Hokkaido Hospital Kushiro, Japan
Further Information

Publication History

Publication Date:
31 January 2002 (online)

Also available at
    Permissions and Reprints

ABSTRACT

Progressive valgus ankle deformity is a problematic postoperative donor-site morbidity of a vascularized fibular graft in children. To prevent this complication, tibiofibular metaphyseal synostosis (the Langenskiöld procedure) has been recommended. The authors objectively evaluated the preventive and therapeutic effects of this procedure on five children who had received free vascularized fibular grafts. Their average age at the time of operation was 3 years (range: 1 to 9 years). The Langenskiöld procedure was performed primarily in four patients, and not in one patient. The anteroposterior (A-P) mortise angle and the empirical axis of the donor-site ankle were measured radiographically. With regard to the A-P mortise angle, four of five patients showed valgus with a mild lateral wedging of the distal tibial epiphysis. The patient who did not receive the operation showed the largest A-P mortise angle and mild osteoarthritic changes. The empirical axis exceeded normal range in all of the five patients. These observations indicated that valgus deformity of the ankle in children after harvesting a vascularized fibular graft is inevitable, even if the Langenskiöld procedure is performed. The procedure can delay the ankle valgus. The authors recommend close follow-up of the children who receive the Langenskiöld procedure after harvesting a vascularized fibular graft.

KEYWORD

Vascularized fibular graft - valgus deformity - ankle - donor-site morbidity

REFERENCES

  • 1 Jupiter J B, Bour C J, May J W. The reconstruction of defects in the femoral shaft with vascularized transfer of fibular bone.  J Bone Joint Surg . 1987;  65A 365
    PubMedGoogle Scholar
  • 2 Minami A, Usui M, Ogino T, Minami M. Simultaneous reconstruction of bone and skin defects by fibular graft with a skin flap.  Microsurgery . 1986;  7 38
    CrossrefPubMedGoogle Scholar
  • 3 Taylor G I. The current status of free vascularized bone grafts.  Clin Plast Surg . 1983;  10 185
    PubMedGoogle Scholar
  • 4 Omokawa S, Tamai S, Takakura Y. A long-term study of the donor-site ankle after vascularized fibula grafts in children.  Microsurgery . 1996;  17 162
    CrossrefPubMedGoogle Scholar
  • 5 Ganel A, Yaffe B. Ankle instability of the donor site following removal of vascularized fibula bone graft.  Ann Plast Surg . 1990;  24 7
    CrossrefPubMedGoogle Scholar
  • 6 Pho R WH, Levack B, Satku K, Patradul A. Free vascularized fibular graft in the treatment of congenital pseudarthrosis of the tibia.  J Bone Joint Surg . 1985;  67B 64
    PubMedGoogle Scholar
  • 7 Weiland A J, Weiss A PC, Moore J R, Toro V T. Vascularized fibula grafts in treatment of congenital pseudarthrosis of the tibia.  J Bone Joint Surg . 1990;  72A 654
    PubMedGoogle Scholar
  • 8 Zuker R M. Vascularized bone grafts for congenital pseudarthrosis of the tibia.  Microsurgery . 1996;  17 470
    PubMedGoogle Scholar
  • 9 Minami A, Kasashima T, Iwasaki N. Vascularised fibular grafts: an experience of 102 patients.  J Bone Joint Surg . 2000;  82B 1022
    PubMedGoogle Scholar
  • 10 Monji J. Roentgenological measurement of the shape of the osteoarthritic ankle.  J Jpn Orthop Assoc . 1980;  54 791
    PubMedGoogle Scholar
  • 11 Langenskiöld A. Pseudoarthrosis of the fibula and progressive valgus deformity of the ankle in children: treatment by fusion of the distal tibial and fibular metaphyses.  J Bone Joint Surg . 1967;  49A 463
    PubMedGoogle Scholar
  • 12 Nakai T, Takakura Y, Tanaka Y. Morphologic changes of the ankle in children as assessed by radiography and arthrography.  J Orthop Sci . 2000;  5 134
    CrossrefPubMedGoogle Scholar
  • 13 Wiltse L L. Valgus deformity of the ankle.  J Bone Joint Surg . 1972;  54A 595
    PubMedGoogle Scholar
  • 14 Moon M S, Rhee S K, Lee H D. Valgus ankle secondary to acquired fibular pseudoarthrosis in children: long-term results of the Langenskiöld operation.  Bull Hosp Jt Dis . 1997;  56 149
    PubMedGoogle Scholar
  • 15 Hsu L CS, Yau A M C C, O'Brien J P, Hodgson A R. Valgus deformity of the ankle resulting from fibular resection for a graft in subtalar fusion in children.  J Bone Joint Surg . 1972;  54A 585
    PubMedGoogle Scholar
  • 16 Dias L S. Valgus deformity of the ankle joint: pathogenesis of fibular shortening.  J Pediatr Orthop . 1985;  5 176
    PubMedGoogle Scholar
  • 17 Love S M, Ganey T, Ogden J A. Postnatal epiphyseal development: the distal tibia and fibula.  J Pediatr Orthop . 1985;  5 176
    PubMedGoogle Scholar
  • 18 Kärrholm J, Hansson L I, Selvik G. Changes in tibiofibular relationships due to growth disturbances after ankle fractures in children.  J Bone Joint Surg . 1984;  66A 1198
    PubMedGoogle Scholar
  • 19 Pritchett J W. Growth and growth prediction of the fibula.  Clin Orthop . 1997;  334 250
    PubMedGoogle Scholar
  • 20 Hsu L C, O'Brien J P, Yau A C, Hodgson A R. Valgus deformity of the ankle in children with fibular pseudarthrosis: results of treatment by bone-grafting of the fibula.  J Bone Joint Surg . 1974;  56A 503
    PubMedGoogle Scholar
  • 21 Frick S L, Shoemaker S, Mubarak S J. Altered fibular growth patterns after tibiofibular synostosis in children.  J Bone Joint Surg . 2001;  83A 247
    PubMedGoogle Scholar
  • 22 Stevens P M, Belle R M. Screw epiphysiodesis for ankle valgus.  J Pediatr Orthop . 1997;  17 9
    CrossrefPubMedGoogle Scholar
  • 23 Lambert K L. The weight-bearing function of the fibula. A strain gauge study.  J Bone Joint Surg . 1971;  53A 507
    PubMedGoogle Scholar
  • 24 Wang Q, Whittle M, Cunningham J, Kenwright J. Fibula and its ligaments in load transmission and ankle joint stability.  Clin Orthop . 1996;  330 261
    PubMedGoogle Scholar
  • 25 Scranton Jr E P, McMaster J H, Kelly E. Dynamic fibular function: a new concept.  Clin Orthop . 1976;  118 76
    PubMedGoogle Scholar