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Introduction: Composite perigenual defects (CPGDs) are exacting the expertise of the reconstructive surgeons. Segmental skeletal defects continue to be a challenge for both orthopedic and plastic surgeons. There are many techniques available for the reconstruction of segmental skeletal defects in the perigenual region. This study explores the outcomes of pedicled chimeric propelled osteomyocutaneous fibula flap reconstruction of post traumatic and post excisional composite perigenual defects (CPGDs) MATERIALS AND METHODS: It was a retrospective study conducted from 2011 to 2016 including 16 patients (5 post excisional defects and 11 post traumatic defects). 14 males and 2 females were included. Ages of the patients were ranging from 24 to 46 years. All had their CPGDs reconstructed with chimeric pedicled propelled fibula osteomyocutaneous flap RESULTS: All 15 patients on an average of 26 months follow-up assumed pain free unrestrictive walking. Fracture of hardware and transferred fibula occurred in one case 2 1/2 years following the surgery. Other patients had good functional recovery in an average of 26 months follow up. The average MSTS score of 15 patients was 23.9.Conclusion: This anatomically construed procedure will be addendum to the armamentarium of reconstruction in both post excisional limb salvage milieu and secondary posttraumatic context for the perigenual composite defects. With high healing potential, infection culling capacity, high osteogenic potential and good supportive hardwares the pedicled osteomyocutaneous fibula flap may usher in better outcome in composite perigenual defects reconstruction. [ABSTRACT FROM AUTHOR]

Highlights: [•] The study is focused on the occurrence of nerve abnormalities (size and echotexture) at ultrasonographic examination in fibular nerve conduction block and relationship with neurophysiological findings. [•] The study shows that a normal ultrasound is usually present in a fibular nerve conduction block, but in case of additional axonal damage is associated with an increase of cross sectional area. [•] The importance of our study is the possible diagnostic/prognostic value of the ultrasound in cases of fibular nerve conduction block: normal CSA might indicate a better prognosis. [ABSTRACT FROM AUTHOR]

Abstract: E/FA is the combination of ectrodactyly (split hand/foot malformation, SHFM) and fibular aplasia. It is a rare disorder considered to be inherited in an autosomal dominant fashion with reduced penetrance and variable expression. In order to determine recurrence risks for the two patients we describe, the literature on inheritance of E/FA was carefully reviewed. In our opinion, only two of the eight families previously reported as examples of familial E/FA may fit this judgment. Until mutation analysis of all SHFM genes is possible, the question remains whether these familial cases represent autosomal dominant E/FA, or an allelic variant of an SHFM subtype. Many sporadic patients with presumed E/FA may represent the fibular developmental field defect, which is a non-genetic entity with a low recurrence risk. We therefore suggest that the high recurrence risk associated with autosomal dominant inheritance should not be counselled in patients with E/FA unless their family shows the following characteristics: (1) at least one patient shows typical SHFM combined with fibular aplasia, (2) multiple limbs are affected, and (3) multiple family members are affected in at least two generations. [Copyright &y& Elsevier]

Abstract: We present the first ever reported case of bilateral total knee replacements in a congenital amputee with bilateral fibular deficiency. A 60year old woman with bilateral fibular hemimelia presented with advanced osteoarthritis in both her knees for which bilateral total knee replacements was performed. The left knee replacement was followed up at 12months and the right knee at 7years. Oxford knee scores improved from 14 to 40 for the left knee and were 37 for the right knee. She was able to walk independently to a distance beyond 400 m. Modification in the surgical procedure and postoperative rehabilitation is discussed. Mid-term follow-up of 7years reaffirms total knee replacement as a viable option for below knee amputees with knee osteoarthritis. [Copyright &y& Elsevier]

Objective Fibular hemimelia or longitudinal fibular deficiency is the most frequent congenital malformation of lower limbs. It causes sometimes major limbs shortening. Different treatments could be considered depending on the severity of the malformation: contralateral epiphysiodesis, corrective foot and knee osteotomies, leg-lengthening surgery with external fixation, prosthesis. For the most severe cases (15–20 cm bone length discrepancies or unstable knee or foot), leg-lengthening surgery with external fixation is not recommended. In both cases, there are two potential treatments: orthopedic treatment wearing orthoprosthesis or trans-tibial amputation surgery. Choice is complex and there is no clear objective recommendation for one or the other option. Some parents prefer amputation with removal of portions of the legs to prepare them for prosthetic use. This usually takes place during the first few years of their child. Others will let the child decide when they become teenagers or adults. What are the key factors that could help physical medicine and rehabilitation doctors to guide family in taking this tough decision? Observations We followed a 13-year-old boy suffering from longitudinal fibular deficiency before and after his treatment with trans-tibial amputation. We researched objective data on walk analysis based on a representative sample combined with a subjective study on quality of life using the VSP-A questionnaire. We collected data one month before the amputation and one month, four months and one year post-amputation. Discussion/Conclusion We could not clearly find out significant objective walk criterion before or after surgery. In both cases, we observed compensatory and adaptive mechanisms to anatomical asymmetry initially and acquired later on. Nevertheless, subjective questionnaires highlighted an improvement on a few parameters regarding quality of life after surgery and a major satisfaction from an aesthetic standpoint. This study should be carried out on a bigger scale with a more representative sample population. [ABSTRACT FROM AUTHOR]

Summary: Dysfunction of the lower limb''s muscles can cause severe impairment and immobilisation of the patient. As one of the leg''s major motor and sensory nerves, the deep peroneal nerve (synonym: deep fibular nerve) plays a very important role in muscle innervation in the lower extremities. We report the case of a 19-year-old female patient, who suffered from a brace-like exostosis 6-cm underneath her left fibular head causing a partially irreversible paresis of her deep peroneal nerve. This nerve damage resulted in complete atrophy of her extensor digitorum longus and extensor hallucis longus muscle, and in painful sensory disturbance at her left shin and first web space. The tibialis anterior muscle stayed intact because its motor branch left the deep peroneal nerve proximal to the nerve lesion. Diagnosis was first verified 6 years after the onset of symptoms by a magnetic resonance imaging (MRI) scan of her complete left lower leg. Subsequently, the patient was operated on in our clinic, where a neurolysis was performed and the 4-cm-long osteocartilaginous exostosis was removed. Paralysis was already irreversible but sensibility returned completely after neurolysis. The presented case shows that an osteocartilaginous exostosis can be the cause for partial deep peroneal nerve paresis. If this disorder is diagnosed at an early stage, nerve damage is reversible. Typical for an exostosis is its first appearance during the juvenile growth phase. [Copyright &y& Elsevier]