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Complications related to harvest of the proximal end of the fibula: A systematic review

Complications related to harvest of the proximal end of the fibula: A systematic review

Authors :
Rey Ramirez
Douglas M. Sammer
Craig R. Lehrman
Oded Ben Amotz
Sumeet S. Teotia
Tarik Husain
Source :
Microsurgery. 34:666-669
Publication Year :
2014
Publisher :
Wiley, 2014.

Abstract

Background: The fibula is a common source of bone graft used in skeletal reconstruction. Although in most cases only the diaphysis of the fibula is used, there are clinical scenarios in which the proximal end of the fibula and fibular head are harvested for use in articular reconstruction. The purpose of this systematic review is to determine the incidence of knee instability and peroneal nerve motor dysfunction associated with removal of the proximal end of the fibula and fibular head. Methods: A systematic search was performed using the PubMed, Ovid MEDLINE, and cochrane databases. Studies accepted for review included those that clearly reported donor site morbidity (instability or peroneal nerve motor dysfunction) after proximal fibula resection. All studies in which the proximal fibula was resected for bone graft or for marginal resection of tumor were included. Results: Fifteen studies reporting a total of 337 patients were included. The rate of symptomatic knee instability after proximal fibula resection was 3.9%. The incidence of instability that was detectible on physical examination or stress radiographs was higher. Although transient motor dysfunction was not uncommon, the incidence of persistent peroneal nerve motor dysfunction was 2.6%. Conclusion: Although asymptomatic laxity is common, the incidence of symptomatic knee instability after resection of the proximal fibula is relatively low. The incidence of persistent peroneal nerve motor dysfunction is also low when the nerve is intentionally protected during surgery. V C 2014 Wiley Periodicals, Inc. Microsurgery 00:000‐000, 2014. Free vascularized fibula grafts are commonly used for the reconstruction of bony defects in the head and neck, extremities, spine, and pelvis 1‐7 and avascular necrosis of femoral head. 8 Most commonly, the mid-portion of the fibula is harvested, with preservation of the proximal and distal articulations. It is recommended that the proximal 4‐8 cm of the fibula be preserved in order to prevent knee instability and to avoid injury to the peroneal nerve. 9‐11 However, the proximal end of the fibula, including the fibular head, has proven useful in the reconstruction of the distal end of the radius and the proximal end of the humerus. 12,13 The fibular head has also been used in reconstruction of the mandibular condyle. 14 In the literature, the reported incidence of postoperative knee instability after resection of the proximal fibula ranges from 0 to 50%, 15‐29 and the incidence of peroneal nerve motor loss ranges from 0 to 10%. 15‐29 The purpose of this literature review is to determine the incidence of knee instability and persistent peroneal nerve motor dysfunction after resection of the proximal fibula.

Details

ISSN :
07381085
Volume :
34
Database :
OpenAIRE
Journal :
Microsurgery
Accession number :
edsair.doi...........6f1564ac1939371f4ae6ca705dedf230
Full Text :
https://doi.org/10.1002/micr.22309