Valgus Deformity After Fibular Resection in Children

Author(s): Gonzalez-Herranz P, del Rio A, Burgos J, Lopez-Mondejar JA, Rapariz JM

Source:  J Pediatric Orthop 23(1): 55-59, 2003


The fibula is frequently a site of bone harvest for vascularized grafts to bridge large bone defects.  The use of the fibula as a free graft in a skeletally immature individual has received little attention.  Twenty-three patients who underwent twenty-four fibular resections greater than 2cm in length were included as the cohort.  Not all children underwent free vascularized transfers, but many had resection of bone for additional problems.  In one-half of the cases, the tibiofibular joint was stabilized with a screw or K-wire.  The children were evaluated at a mean of 6.2 years, (range,  4-11 years). Multiple measurements were obtained to assess the affect of fibular resection on ankle stability and alignment.  A variety of abnormalities were found at radiographic follow-up. Valgus deformity of the tibia was observed in five cases (20%).  Alteration of the tibiotalar angle and proximal migration of the lateral malleolus were also found in 45% and 55% of the cases, respectively.

The fibula is an ideal bone to use as a source for vascularized bone transfer.  Similar to the distal ulna, the fibula is involved in load transfer within the leg.  The fibula normally incurs approximately 7% of the load.  Previous clinical studies indicate that fibula resection is not a benign procedure.  Sequelae include ankle instability, weakness, and pain.  Preservation of at least 8cm. of distal fibula has been recommended to avoid ankle instability.  Failure to preserve and possibly stabilize the distal 8cm may alter load-bearing and lead to a valgus deformity.  Asymmetrical load distribution may result altered growth.  Saving the distal 8cm of the fibula combined with syndesmotic screw fixation to avoid malleolar ascent is recommended.  

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J Pediatric Orthop