Double‐barrel vascularized dual fibula transfer with epiphyseal growth plate for hip reconstruction: A case report

Abstract

We present a case report of a 10-year-old girl diagnosed with Ewing sarcoma treated with intra-articular wide resection of the right femur and reconstruction with a series-connected double-barrel bilateral vascularized fibula graft (db-BVFG), including fibular head for articulation with the acetabulum of the pelvic bone and preservation of the epiphyseal growth plates for eventual limb growth. No postoperative complications were observed and bone union was achieved with fibular graft hypertrophy, allowing for full weight bearing. Neither local recurrence nor metastasis was observed at 17-year follow-up. Range of motion degrees at last follow up: hip flexion 90 degree, extension 12 degree, abduction 31 degree, rotation 25 degree. Right versus left limb discrepancy was 60 mm. Db-BVFG may be an option for reconstruction of long femoral defects and hip joint restoration following tumor resection and inclusion of epiphysis within the graft is a viable option in pediatric patients to restore longitudinal growth of the reconstructed long bone.

Complication of osteo reconstruction by utilizing free vascularized fibular bone graft

“…The cases of using vascularized fibular epiphysis to reconstruct the lower extremity is small and the effectiveness is dissatisfactory. There were overall only 4 cases about hip [ 51 , 52 ], 3 about the femur [ 53 – 55 ] and 3 case of lower leg [ 49 ]. The result of fibular epiphyseal transfer in hip articular reconstruction was the worst, while only one successful case (out of 4 cases) has been reported [ 51 ].…”

“…But it should be noted that the diameter of fibula is not commensurate with that of femur. To provide a diameter-match, Fabio [53] introduced a double-barrel vascularized fibular graft for femur reconstruction, and both grafts experienced significant diameter (200%) and length growth (15%).…”

Vascularized Fibular Epiphyseal Transfer for Pediatric Limb Salvage: Review of Applications and Outcomes

“…Oncologic indications most commonly included osteosarcoma and Ewing sarcoma. 2,3,5,6,[8][9][10][12][13][14][16][17][18][19]21,[23][24][25]27,[31][32][33][36][37][38]40 Congenital deformities included radial longitudinal deficiency and ulnar pseudarthrosis. 19,22,23,27,30,35 Traumatic injuries involved the lateral malleolus, calcaneus, radius, and ulna.…”

“…Table 1 details the summary of VFET technique considerations extracted from these articles to help guide surgical planning. 2,3,5–42…”

“…5,25,26 Following inset of VFET at the recipient site, muscle reattachment and soft tissue reconstruction were performed to support the reconstructed joint. 13,18,37 Examples of ligamentous reconstruction using the biceps femoral tendon included wrapping it around the coracoid process of the scapula or anchoring it to the glenoid capsule for shoulder stabilization, 3,10,14 weaving it into the residual capsule to stabilize the radiocarpal joint in distal radius and ulna reconstruction, 8,22,23 helping reconstruct calcaneal ligaments in ankle reconstruction, 15,20,31 and suturing it into the remaining capsular ligament of the TMJ in mandible reconstruction. 17 Postoperative protocols entailed immobilization followed by rehabilitation with progressive range of motion…”