Gap nonunion of tibia treated by Huntington′s procedure

Kundu, Zile Singh; Gupta, Vineeta; Sangwan, Sukhbir Singh; Kamboj, Pardeep

doi:10.4103/0019-5413.104197

Cited by 13 publications

(10 citation statements)

References 19 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The non-vascularised fibular graft has been reported previously in the literature for large tibial defects, but more commonly following tumour4 7 or infection8–10 than in trauma cases7 10 11 and more often in the adult7 10 11 than the paediatric population 4 7…”

Section: Discussionmentioning

confidence: 96%

Ipsilateral fibular transfer as a salvage procedure for large traumatic tibial defects in children in an austere environment

Keenan

Tubb

et al. 2016

J R Army Med Corps

View full text Add to dashboard Cite

Large tibial defects present a challenging scenario for the orthopaedic surgeon, particularly in the paediatric patient. Most management options, such as the vascularised fibular graft or Ilizarov technique, require microsurgical techniques or specialist equipment. In an austere environment, acute shortening or limb amputation may be most appropriate. However, limb salvage may be achieved by ipsilateral fibular transfer. In a one-stage operation, the fibular graft is harvested and either placed in the tibial defect in an intramedullary position or secured to the tibia with screws. We present two paediatric cases where this approach was used to preserve the lower limb despite extensive explosive trauma. In the first case, an 11 cm tibial defect was managed with an ipsilateral fibular graft. The graft was placed in an intercalary position proximally, with medial displacement of the ankle and fixation of the fibula as a strut graft. In the second case, a 10 cm tibial defect was managed with an ipsilateral fibular graft, using intercalary placement proximally and distally. Both children returned to weight bearing with crutches within several months of surgery. For large tibial defects, ipsilateral fibular transfer is an effective one-stage operation that represents a viable alternative to amputation in austere environments.

show abstract

Section: Discussionmentioning

confidence: 96%

Ipsilateral fibular transfer as a salvage procedure for large traumatic tibial defects in children in an austere environment

Keenan

Tubb

et al. 2016

J R Army Med Corps

View full text Add to dashboard Cite

show abstract

“…The use of K-wire obviates the need for a second surgery which would have been the case if a screw or plate was used. Cancellous bone graft at the proximal and distal ends of the graft site would have hastened the healing process but again we decided otherwise to reduce the patient's morbidity [16] [17].…”

Section: Discussionmentioning

confidence: 99%

“…It also saves the patient the risk of morbidity associated with contra-lateral fibular harvest. It is therefore a viable option in resource poor rural and sub rural setting [16] [17].…”

Section: Discussionmentioning

confidence: 99%

Tibialization of Fibula in Treatment of Major Bone Gap Defect of the Tibia: A Case Report

Nwokike¹,

Esezobor²,

Olomu³

et al. 2015

OJO

View full text Add to dashboard Cite

Gap bone defect is a major challenge. Its treatment has evolved over the years from amputation to limb reconstruction through vascularised graft, distraction osteogenesis and use of customised implants. Availability and affordability of these innovative techniques have always been an additional challenge in the developing resource poor countries. We report the use of Tibialization of Ipsilateral fibula first suggested by Hahns in 1884 to bridge a gap of 12 cm in an 8 year old male, with segmental tibia loss from chronic osteomyelitis. We did an end to end transposition of the ipsilateral fibular into the tibia gap defect in a one stage procedure. This was after eradication of the infective process of osteomyelitis. He commenced partial weight bearing ambulation in cast at 3 months and out of cast ambulation at 18 months post surgery. The transposed fibula was 75% tibialized at 18 months post surgery. Conclusion: Fibular is a useful armamentarium in filling segmental bone defect.

show abstract

“…The fibula is completely surrounded by muscles and has an abundant vascular supply which supports its hypertrophy and union at the synostotic site [ 17 , 18 ]. The reduction in lower leg volume due to the antero-medial shift of the fibula makes skin closure easier, even in patients with scarred tissue [ 19 ]. The procedure is restricted to the ipsilateral limb, unlike those cases in which contralateral fibula is used as a vascularized graft, which helps reduce morbidity.…”

Section: Discussionmentioning

confidence: 99%

The Huntington procedure: Still a reasonable option for large tibial defects in paediatric patients

Gupta

Garg

2014

Journal of Children's Orthopaedics

View full text Add to dashboard Cite

BackgroundManagement of gap nonunion of tibia is technically difficult, time consuming, physically and psychologically demanding for the patient with unpredictable results. Various techniques have been described in literature for the treatment of gap nonunions, but each one has its own limitations.PurposeThis study reports the outcomes of ipsilateral fibular transposition for reconstruction of tibial defects in paediatric age group.MethodsWe retrospectively reviewed records of 14 patients who underwent surgery for gap nonunion tibia with ipsilateral tibialization of fibula. Fibula is transferred to tibia as pedicle graft in two-staged procedure. Due to retained blood supply to one end of the transplant, the graft easily takes up and hypertrophies upon weight bearing over a period of time.ResultsAverage time of radiographic union was 13.35 weeks. Guarded partial weight bearing was started at an average of 16.5 weeks with gradual progression to full weight bearing. The leg length discrepancy at final follow-up ranged from 0 to 7 cms with an average of 2.60 cms. Hypertrophy of tibialized fibula was observed in all patients, with 8 patients showed grafted fibula reaching the diameter of opposite tibia. On subjective assessment, 9 patients were highly satisfied, 4 patients were satisfied and one patient was dissatisfied with the procedure.ConclusionsHuntington procedure is a simple, cost-effective and easy procedure for large tibial defects in paediatric patients which does not require any specialized team and implants, and can be performed in moderately equipped hospital. Leg length discrepancy may be addressed, after the transferred fibula is well developed.

show abstract

Gap nonunion of tibia treated by Huntington′s procedure

Cited by 13 publications

References 19 publications

Ipsilateral fibular transfer as a salvage procedure for large traumatic tibial defects in children in an austere environment

Ipsilateral fibular transfer as a salvage procedure for large traumatic tibial defects in children in an austere environment

Tibialization of Fibula in Treatment of Major Bone Gap Defect of the Tibia: A Case Report

The Huntington procedure: Still a reasonable option for large tibial defects in paediatric patients

Contact Info

Product

Resources

About