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.
Similar content being viewed by others
References
Sulaiman AR, Wan Z, Awang S, Che Ahmad A, Halim AS, Ahmad Mohd Zain R (2015) Long-term effect on foot and ankle donor site following vascularized fibular graft resection in children. J Pediatr Orthop B 24:450–455
Nathan SS, Athanasian E, Boland PJ, Healey JH (2009) Valgus ankle deformity after vascularized fibular reconstruction for oncologic disease. Ann Surg Oncol 16:1938–1945
Iamaguchi RB, Fucs PM, da Costa AC, Chakkour I (2011) Vascularised fibular graft for the treatment of congenital pseudarthrosis of the tibia: long-term complications in the donor leg. Int Orthop 35:1065–1070
Kanaya K, Wada T, Kura H, Yamashita T, Usui M, Ishii S (2002) Valgus deformity of the ankle following harvesting of a vascularized fibular graft in children. J Reconstr Microsurg 18:91–96
Omokawa S, Tamai S, Takakura Y, Yajima H, Kawanishi K (1996) A long-term study of the donor-site ankle after vascularized fibula grafts in children. Microsurgery 17:162–166
Fragnière B, Wicart P, Mascard E, Dubousset J (2003) Prevention of ankle valgus after vascularized fibular grafts in children. Clin Orthop Relat Res 408:245–251
Xin Z, Kim K, Jung S (2009) Regeneration of the fibula using a periosteum-preserving technique in children. Orthopedics 32:820
Agarwal A, Kumar A (2016) Fibula regeneration following non-vascularized graft harvest in children. Int Orthop 40:2191–2197
Pacelli LL, Gillard J, McLoughlin SW, Buehler MJ (2003) A biomechanical analysis of donor-site ankle instability following free fibular graft harvest. J Bone Joint Surg Am 85:597–603
Soejima O, Ogata K, Ishinishi T, Fukahori Y, Miyauchi R (1994) Anatomic considerations of the peroneal nerve for division of the fibula during high tibial osteotomy. Orthop Rev 23:244–247
Malhotra D, Puri R, Owen R (1984) Valgus deformity of the ankle in children with spina bifida aperta. J Bone Joint Surg Br 66:381–385
Stevens PM (2015) Pediatric ankle valgus: background, anatomy, pathophysiology. emedicine.medscape.com/article/1358051-overview. Accessed 15 March 2016
Cox JS, Hewes TF (1979) “Normal” talar tilt angle. Clin Orthop Relat Res 140:37–41
Steinlechner CW, Mkandawire NC (2005) Non-vascularised fibular transfer in the management of defects of long bones after sequestrectomy in children. J Bone Joint Surg Br 87:1259–1263
González-Herranz P, del Río A, Burgos J, López-Mondejar JA, Rapariz JM (2003) Valgus deformity after fibular resection in children. J Pediatr Orthop 23:55–59
Kang SH, Rhee SK, Song SW, Chung JW, Kim YC, Suhl KH (2010) Ankle deformity secondary to acquired fibular segmental defect in children. Clin Orthop Surg 2:179–185
Morgan JD (1959) Blood supply of growing rabbit’s tibia. J Bone Joint Surg Br 41:185–203
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no conflict of interest.
Funding
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.
Rights and permissions
About this article
Cite this article
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
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00264-017-3403-8