Valgus Deformity of the Ankle Following Harvesting of a Vascularized Fibular Graft in Children

Abstract

Progressive valgus ankle deformity is a problematic postoperative donor-site morbidity of a vascularized fibular graft in children. To prevent this complication, tibiofibular metaphyseal synostosis (the Langenskiöld procedure) has been recommended. The authors objectively evaluated the preventive and therapeutic effects of this procedure on five children who had received free vascularized fibular grafts. Their average age at the time of operation was 3 years (range: 1 to 9 years). The Langenskiöld procedure was performed primarily in four patients, and not in one patient. The anteroposterior (A-P) mortise angle and the empirical axis of the donor-site ankle were measured radiographically. With regard to the A-P mortise angle, four of five patients showed valgus with a mild lateral wedging of the distal tibial epiphysis. The patient who did not receive the operation showed the largest A-P mortise angle and mild osteoarthritic changes. The empirical axis exceeded normal range in all of the five patients. These observations indicated that valgus deformity of the ankle in children after harvesting a vascularized fibular graft is inevitable, even if the Langenskiöld procedure is performed. The procedure can delay the ankle valgus. The authors recommend close follow-up of the children who receive the Langenskiöld procedure after harvesting a vascularized fibular graft.

Free vascularized fibular grafting for reconstruction after tumor resection in the upper extremity

“…Apart from these complications, only minor complications were recorded in this study. There was a low rate of wound healing difficulties and a very low rate of donor-site morbidity, with two peroneal nerve irritations and four lower limb anatomical and functional complications, the majority of which developed as a result of the neurological complications, (in three patients) [52][53][54][55]. This low rate may be a benefit of using VFG in patients with a younger average age, as in this study [13,56].…”

Vascularised fibular graft for the treatment of congenital pseudarthrosis of the tibia: long-term complications in the donor leg

“…Many authors recommend arthrodesis or transfixation with a screw of the distal tibiofibular joint in patients with open physis, in order to avoid the valgus deformity of the ankle and proximal migration of the lateral malleolus [5,7,9,11,15,17,22]. Although we frequently observed proximal migration of the lateral malleolus, we could not associate this with clinical complications.…”

Lateral Ankle Stabilization After Distal Fibular Resection Using a Novel Approach: A Surgical Technique

“…Failure to reconstruct the lateral ligaments after fibula resection has been associated with progressive valgus deformity of the ankle and a talar tilt with ankle instability and progression to early arthrosis [1,14,15,20]. For this reason, reconstruction is necessary after resection of the distal fibula.…”

“…Complications from these reports range from progressive valgus deformity [15,20], gait abnormalities from ankle contractures and abnormal talar tilt [1,14], lateral knee instability with peroneal nerve injury [2,10], ankle and subtalar arthritis [7,18], growth plate injury of the immature distal tibia, to absolutely no effect at all on the functional outcome of the limb [3,19,20,26].…”