Fibular lengthening by Ilizarov method secondary to shortening by osteochondroma of distal tibia

Abstract

Osteochondroma is the most common benign bone tumour. They most commonly affect the long tubular bones and almost half of osteochondromata are found around the knee. Osteochondroma arising from the distal metaphysis of the tibia typically result in a valgus deformity of the ankle joint secondary to relative shortening of the fibula. This case describes the use of Ilizarov technique for fibular lengthening following excision of a distal tibial osteochondroma. A 12-year-old girl presented with a 3-year history of a large swelling affecting the lateral aspect of the right distal tibia. Plain radiographs confirmed a large sessile osteochondroma arising from the postero-lateral aspect of the distal tibia with deformity of the fibula and 15 mm of fibular shortening. The patient underwent excision through a postero-lateral approach and subsequent fibular lengthening by Ilizarov technique. The patient made excellent recovery with removal of frame after 21 weeks and had made a full recovery with normal ankle function by 6 months. The Ilizarov method is a commonly accepted method of performing distraction osteogenesis for limb inequalities; however, this is mainly for the tibia, femur and humerus. We are unaware of any previous cases using the Ilizarov method for fibular lengthening. This case demonstrates the success of the Ilizarov method in restoring both fibular length and normal ankle anatomy.

Fibular Lengthening for the Management of Translational Talus Instability in Hereditary Multiple Exostoses Patients

“…8 We used a ring or a ring-bar hybrid external fixator to purchase the tibia in early 2 cases (Table 1). However, in most cases thereafter, we adopted a fibula-only purchasing technique using monolateral fixator and now prefer the latter method.…”

“…6 The ankle pain in HME patients may be attributed to the tumor itself, irritation of tendon or nerve, or an inflamed bursa over the tumor. [6][7][8] Deformities of the ankle occur in 45% to 54% of affected individuals. 9,10 The characteristic valgus deformity of the ankle is associated with relative shortening of the fibula and lateral tapering of the distal tibial epiphysis.…”

Transfibular excision of distal tibial interosseous osteochondroma with reconstruction of fibula using Sofield's technique – A case report

“…10 Johnston et al have lengthened the fibula using the Ilizarov method. 11 An allograft construction 12 has also been described but such complex surgeries are usually described for malignant cases. An alternative method is an arthrodesis of the tibiotalar joint.…”

Limb Length Discrepancy and Angular Deformity due to Benign Bone Tumors and Tumor-like Lesions

“…The approach is similar to the forearm—excise the osteochondroma and lengthen the fibula by external fixation–assisted distraction-osteogenesis. 50 Lee et al 51 lengthened 12 fibulas in nine patients an average of 15.3 mm using a monolateral fixator with normalization of the medial talar clear space and correction of gross instability of the ankle.…”