Invited Discussion

This is a case report which highlights slippage of the peroneal tendon at the osteotomy site of the remnant fibula, an entity that has been recognized as a potential problem, but does not warrant surgical interference by many people. In this case, the problem is too symptomatic to warrant further shortening of the fibula.

The reconstruction of the donor leg of the remnant fibula is important in preventing this type of complication. Very often, a transfixation screw is utilized to fix remnant fibula to tibia, to insure reinforcement and to prevent proximal migration of the fibula, or the fibula can become tilted with anterior angulation, thus contributing to slippage of the peroneal tendon.

Donor morbidity of the fibula, including a tight flexor hallucis longus, is commonly seen. Other severe complications might include compartment syndrome when an osteocutaneous flap is raised, and the possibility of deep vein thrombosis in the elderly.

Bony complications, including proximal migration of the lateral malleolus, postero-anterior tilting, angulation, and osteoporosis of the remnant fibula have all been observed.