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Ankle valgus following non-vascularized fibular grafts in children—an outcome evaluation minimum two years after fibular harvest

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Abstract

Background

The literature on ankle valgus development after procuring non-vascularised fibular grafts in children is still scanty. The non-vascularised fibular graft has distinction of fibular regeneration occurring at the donor site.

Material and methods

We retrospectively analysed the valgus deformities at the donor leg following harvest of non-vascularised fibular graft to determine the various contributing factors in growing children. All these patients had minimum two years post index procedure follow up.

The radiological ankle valgus was quantified using Malhotra’s distal fibular station (0-3), Lateral distal tibial angle (LDTA <84 degrees) and Talar tilt angle >5 degrees. Clinical parameters, evaluated additionally were pain and neuromuscular deficits in the donor limb, if any.

Results

A total of 30 ankles in 23 patients were evaluated. The average patient age was 9.56 years. There was no pain or neuromuscular deficit in the examined limbs at a mean follow up of 39.4 months. The continuity of the fibula in the longitudinal dimension was already restored in 90% limbs. There was presence of radiological valgus deformity in 10 (33%) ankles. The LDTA was abnormal in 80% and talar tilt in 50% valgus ankles. The ankle valgus deformity was found despite the presence of a normal Malhotra station 0. The age of the patient did not seem to influence the ankle valgus deformity.

Conclusions

Radiological ankle valgus is a common occurrence even following non-vascularised fibular harvest. The presence of a regenerated fibula in continuity (90% legs) and almost of similar anatomical longitudinal dimensions (97%) did not deter development of valgus deformity at ankle.

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Authors and Affiliations

  1. Department of Paediatric Orthopaedics, Chacha Nehru Bal Chikitsalaya, Geeta Colony, Delhi, 110031, India

    Anil Agarwal, Deepak Kumar, Nargesh Agrawal & Neeraj Gupta

  2. 4/103, East End Apartments, MayurVihar Ph-1 Ext, Delhi, 110096, India

    Anil Agarwal

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  1. Anil Agarwal
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  2. Deepak Kumar
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  3. Nargesh Agrawal
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  4. Neeraj Gupta
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Correspondence to Anil Agarwal.

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The authors declare that they have no conflict of interest.

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There is no funding source.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The Hospital Scientific Committee approved the study.

Informed consent

Informed consent was obtained from all individual (patient’s parents) participants included in the study.

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Agarwal, A., Kumar, D., Agrawal, N. et al. Ankle valgus following non-vascularized fibular grafts in children—an outcome evaluation minimum two years after fibular harvest. International Orthopaedics (SICOT) 41, 949–955 (2017). https://doi.org/10.1007/s00264-017-3403-8

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  • DOI: https://doi.org/10.1007/s00264-017-3403-8

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