Objective To study the reparative and reconstructive for proximal humerus defect due to the excision of bone tumor with noninternal fixation non-vascularised fibular autografts. Methods From June 1991 toDecember 2003, 26 non-vascularised fibular grafts were used as substitutes for repair and reconstruction after resection for bone tumors on proximal humerus. Fifteen cases were given curettage and fibular supporting internal fixation, the other 11 cases were given tumor resection and joint reconstruction with proximal fibular graft. The age ranged from 6 to 41 years. Out of 26 patients, 5 had giant cell tumor, 9 had bone cysts, 8 had fibrous dysplasia and 4 had enchondroma. Results Twenty-six patients were followed up from 1 to 12 years (3.4 years on average). Local recurrence was found in 2 cases, and 1 of them died of lung metastasis. Both outlook and function of the reconstructed joints have good results in 15 proximal humeral joint surface reserved cases. Of them, 3 children gained normal shoulder function 3 weeks after operation. Part function were obtained in the other 11 fibular grafts substituted proximal humeral defect. Conclusion Non-vascularised fibular grafts is an appropriate treatment option for proximal humerus bone defect due to excision of bone tumor.
Objective To compare the long-term results of vascularised fibulargraft and simple autologous fibular graft for reconstruction of wrist after distal bone tumor resection.Methods From January 1979 to September2002, 15 patients with wrist defects due to distal bone tumor resection were treated with vascularised fibular graft or simple autologous fibular graft and followed up 1 year. The results were graded with Enneking’s system and evaluated radiographicallyaccording to the “International Symposium on Limb Salvage”. The grade system included limb function, radiological examination and the function of ankle. Results The limb function of 8 patients with vascularised fibular graft restored to 80% of normal function and the bone union was achieved within 6 months. The limbfunction of 6 patients with simple autologous fibular graft restored to 67% of normal function. The bony union was achieved within 6 months in 4 cases with thebone graft less than 5 cm and in the 13th and 16th months in 2 cases with the bone graft more than 12 cm. Conclusion It is suitable to use the headof fibular boneas a substitute for the distal radius. The healing of vascularised fibular graft is very quick and haven’t the bone resorption. So in the procedure for reconstruction and limb salvage after bone tumor resection of distal radius, the free vascularised fibular graft with fibular head is an ideal substitute.
Objective To investigate the effectiveness of free vascularized fibula grafting with unilateral fibula as donor in treatment of bilateral avascular necrosis of femoral head (ANFH). Methods Between June 2007 and January 2008, 14 patients with bilateral ANFH were treated with free vascularized fibula grafting with unilateral fibula as donor. There were 12males and 2 females with an average age of 36.6 years (range, 17-57 years). The necrosis was caused by use of steroids in 3 cases, consumption of alcohol in 4 cases, and idiopathic condition in 7 cases. According to Steinberg system, 16 hips were classified as stage II, 10 hips as stage III, and 2 hips as stage IV. The preoperative Harris hip scores were 77.50 ± 4.19, 69.70 ± 2.76, 59.50 ± 0.50 in patients at stages II, III, and IV, respectively. The duration of operation and the bleeding volume were recorded. The X-ray examination, the Harris hip score, and the compl ications were used to evaluate the effectiveness. Results The duration of the fibula osteotomy was 10-32 minutes (mean, 20 minutes). The duration of the total operation was 100-240 minutes (mean, 140 minutes). The bleeding volume was 200-500 mL (mean, 280 mL). All patients achieved heal ing of incision by first intention. The patients were followed up 12-40 months (mean, 24 months). One case had numbness and hyperthesia of the anterolateral thigh; 1 case had abnormal sensation of the dorsal foot; 1 case had discomfort of the ankle; and they restored to normal at 1 year after operation. According to X-ray films 1 year after operation, the improvement was achieved in 23 hi ps (82.1%) and no deterioration in 5 hips (17.9%). At 1 year after operation, the Harris hip scores were 93.90 ± 4.84, 88.50 ± 8.13, and 78.00 ± 0.00 inpatients at stages II, III, and IV, respectively, showing significant differences when compared with preoperative ones (P lt; 0.05). Conclusion Unilateral free vascularized fibula grafting has lots of virtues, such as short surgical time, less bleeding volume, l ittle injury, and good results of function recovery. It could be an effective and safe method in treating bilateral ANFH.
The treatmen t of the bone defect of the distal part of the radiu s included repair of the bone defect and resto rat ion of the funct ion of the w rist jo in t. Since 1979, th ree operat ive methods w ere u sed to t reat 13 cases, and they w ere graf t ing of the vascu larized f ibu la by anastom rsis f ibu lar vessels, graf t ing of upper part of f ibu lar w ith lateral inferio rgen icu lar artery and graf t ing vascu larized scapu la f lap. Follow up had been carried ou t from1 to 10 years. The resu lt w as sat isfacto ry. The discu ssion included the repair of the defect of the m iddle o r distal part of the radiu s, the operat ive methods, main at ten t ion s and indications. It was considered that it shou ld be based on the length of bone defect wh ile the operative method was considered.
ObjectiveTo study the clinical efficacy of core decompression and allogeneic nonvascularized fibular grafting on patients with different femoral head necrotic area. MethodsBetween January 2010 and December 2011, 59 hips in 59 patients with Ficat stage Ⅱ osteonecrosis of femoral head were treated with core decompression and allogeneic nonvascularized fibular grafting. Fifty-four patients (54 hips) were followed up. According to the necrotic area of femoral head, patients were divided into three groups: 6 hips in type A, 37 hips in type B and 11 hips in type C. We analyzed the outcomes by changes in radiographic images, Harris hip scores, hip activity and visual analogue scale (VAS) pain scores. The mean follow-up time was 40.1 months. ResultsThe postoperative X-ray images were good with no fibula prolapse, fracture or infection. Six femoral heads collapsed in patients of type C group. No head collapsed in patients grouped into type A or type B. The three groups' Harris hip scores were better than those before surgery (P<0.05). But the Harris hip score of patients with femoral head collapse was as bad as that before surgery (P>0.05). The Harris score of group C was significantly lower than group A and B (P<0.01). The joint movements of type A and type B patients were similar with those before surgery, and the VAS pain score was lower. But patients of type C suffered worse joint movement and the pain was not relieved. ConclusionThe clinical efficacy of femoral head necrotic patients treated with core decompression and allogeneic nonvascularized fibular grafting is generally good. But the risk of femoral head collapse in type C patients is high, and the clinic outcome is worse than patients of type A and B. Therefore this type of surgery is more suitable for patients with type A and B femoral head necrotic area.
Objective To study the effect of surgical treatment with core depression and allo-fibular grafting on osteonecrosis of the femoral head in early stages. Methods From June 1998 to August 2004, 22patients with necrosis of the femoral head (39 hips) were treated with core depression and allo-fibular grafting, indluding 17 males and 5 females. Necrosis was classified as Stages Ⅰ-Ⅲ according to ARCO classification system. Their ages ranged from 22 to 60 years and pain duration was 2 to 12 months preoperatively (6.5 months on average). The regular examinations of joint function, X-ray, ECT,CT and MRI were conducted before surgerg and after 15 days, 3 months, and 6 months of surgery. Results All patients were followed up for 3 to 74 months (31.4 months on average). Symptoms 17 of the patients were relievedevidently. Harris hip score from 78 points preoperatively to 91.6 points.The X-ray films 18 of the patients showed that the geography of the hip joint kept intact with no deterioration. Osteogenesis was observed by regular examinations. Two cases (4 hips, 10.25%) were revised by total hip replacement, and 3 cases (4hips, 10.25%) without THR worsened postoperatively. Conclusion The method is less traumatic than common procedures. The joint function can berecovered within 2.4 weeks. Clinical symptoms are greatly improved. This method is effective at least in short term and the long-term effect needs further study.
Abstract From 1980 to 1985, 21 cases of free transplantation of fibula were performed. There were 6 children in this series, and 4 children were followed up for 9 to 12 years (average 10 years). The Xray showed that distal epiphysis of tibia had a normal width at the medial side and gradully tapered toward the lateral side in a "wedgeshaped" apperance. The articular space of the tibiotalar joint inclined to the fibularside. The hight of the talus was higher laterally, leading to eversion deformity of the ankle joint. The medial and lateral malleoli were smaller than normal, and thus the ankle joint mortise became shallow. The trabeculae of the tibia were irregularly arranged. The lateral cortex of the tibia was thicker than that of the medial one. In one case, the bone density of the lateral side of the "wedgeshaped" epiphysis had increased as high as that ofthe cortex with disappearance of trabeculae. The biomechanics of fibular boneand the mechanism of development of disturbance of ankle joint in childhood were analyzed. Close attention should be paid to this disturbance.
ObjectiveTo investigate the clinical results of locking-plate with an intramedullary fibular allograft for type C2 proximal humeral fracture fixation. MethodsBetween January 2011 and August 2012, 16 patients with proximal humeral fractures (AO type C2) were treated by locking-plate with an intramedullary fibular allograft. The clinical data were retrospectively analysed. There were 5 males and 11 females with an average age of 64 years (range, 55-70 years). The injury causes were falling injury in 12 cases, traffic accident injury in 3 cases, and sports injury in 1 case. The duration between injury and operation ranged from 2 to 6 days (mean, 4.5 days). The imaging data were used to judge the fracture healing, and to measure the neck-shaft angle and the height of humeral head; the disability of arm, shoulder, and hand (DASH) score, short-form 36 health survey scale (SF-36), and Neer score were used to evaluate the function of the shoulder after surgery. ResultsPrimary healing of incision was obtained in all patients; no complication of vascular and nerve injury occurred. Sixteen cases were followed up 12-24 months (mean, 18 months). All fractures healed at 18-24 weeks (mean, 20 weeks). No complication occurred as follows:re-displacement, necrosis, rejection reaction, and loosening or extraction of screws. At last follow-up, the neck-shaft angle was 126.6-136.9° (mean, 132.5°), showing a little lost when compared with intraoperative angle (130.5-138.0°, 134.0° on average). At 12 months after surgery, the height loss of humeral head was 1.8-4.6 mm (mean, 2.0 mm); the passive anteflexion of the shoulder was 130-160° (mean, 148°); the active anteflexion was 120-145° (mean, 136°); the external rotation was 30-65° (mean, 56°); the internal rotation was 15-25° (mean, 19°). And the DASH score was 2-53 (mean, 12); the SF-36 score was 50-95 (mean, 89). According to Neer score for shoulder function, the results were excellent in 10 cases, good in 4 cases, fair in 1 case, and poor in 1 case, with an excellent and good rate of 87.5%. ConclusionLocking-plate with an intramedullary fibular allograft for type C2 proximal humeral fracture fixation has satisfactory clinical results because of stable fixation, high clinical outcome scores, and low internal fixation failure.
Objective To investigate the way to reconstruct bone scaffold afterremoval of giant benign bone tumor in extremities of children. Methods From June 1995 to October 2000, 6 cases of benign bone tumor were treated, aged 614 years. Of 6 cases, there were 4 cases of fibrous hyperplasia of bone, 1 case of aneurysmal bone cyst and 1 case of bone cyst; these tumors were located in humerus (2 cases), in radius (1 case), in femur (2 cases) and in tibia(1 case), respectively. All patients were given excision of subperiosteal affected bone fragment, autograft of subperiosteal free fibula(4-14 cm in length) and continuous suture of in situ periosteum; only in 2 cases, humerus was fixed with single Kirschner wire and external fixation of plaster. Results After followed up 18-78 months, all patients achieved bony union without tumor relapse. Fibula defect was repaired , and the function of ankle joint returned normal. ConclusionAutograft of subperiosteal free fibula is an optimal method to reconstruct bone scaffold after excision of giant benign bone tumor in extremities of children.