Reneration of the donor side after autogenous fibula transplantation in 53 patients

Abstract

We determined the degree of fibular regeneration at the donor site, using radiographs and dual x-ray absorptiometry, in 53 patients who underwent autogenous nonvascularized fibular transplantation for tumor reconstruction in long bones (mean follow-up 15 (3-26) years). Logistic regression was used to determine whether gender, age at transplantation, time since transplantation, bone mineral density (BMD), and length of the graft were associated with fibular regeneration. 26 patients had spontaneous complete bone regeneration. Younger age at transplant was the only predictor of fibular regeneration. In predicting fibular regeneration, sensitivity was 96% and specificity 74%, using 15 years of age as a cut-off. In the long-term follow-up, we found only gradual changes in the BMD and the values ranged from 24% to 217%. We found no correlations of bone mineral density with age, gender, length of the graft, or time since transplantation.

Outcomes and complications of fibular head resection

“…There was no restriction of movement of the ankle and knee joints in our study, in accordance with most other studies [18, 19, 25, 26]. …”

“…Hsu et al and others have also reported on the higher regeneration potential of those of a younger age [26, 31]. The unusual presence of proximal fibula regeneration in a single case in the present study is likely to be due to a favourable balance between interruption of the nutrient artery and the regeneration potential of the vessels and periosteum of a young patient.…”

“…There have been reports of regeneration of the resected fibular shaft [11, 26, 29, 30]; to our knowledge, there have been no reports of regeneration of the proximal third of fibula. Bettin et al [26] studied regeneration of the donor site in 53 patients undergoing transplantation of the fibular shaft and found an age < 15 years to be the only predictor of regeneration.…”

“…Bettin et al [26] studied regeneration of the donor site in 53 patients undergoing transplantation of the fibular shaft and found an age < 15 years to be the only predictor of regeneration. Herranz et al have associated absence or incomplete regeneration of the fibula with the development of valgus deformity of the tibia in children and adolescents.…”

Regeneration of the Fibula with Unidirectional Porous Hydroxyapatite

“…A fibula graft is one of the most common orthopedic procedures for reconstruction of a bone defect, such as after resection of a bone tumor. Reconstruction of the fibula defect after harvesting might not be necessary, because the fibula and interosseous membrane carry only 6% to 16% of the load applied to the lower extremity [10, 11] and spontaneous regeneration of the fibula has been reported previously, especially in children [12]. However, incomplete regeneration or nonunion following fibula harvesting has also been described [1, 13], and the loss of the fibula after its removal sometimes results in significant donor site morbidity, such as surgical scar pain, weaknesses of plantar flexion of the ankle [14], valgus deformity of the ankle [1], ankle instability [15], and tibial fracture [2].…”