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Osteocartilaginous Transfer of the Proximal Part of the Fibula for Osseous Overgrowth in Children with Congenital or Acquired Tibial Amputation by Graham.

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Presentation on theme: "Osteocartilaginous Transfer of the Proximal Part of the Fibula for Osseous Overgrowth in Children with Congenital or Acquired Tibial Amputation by Graham."— Presentation transcript:

1 Osteocartilaginous Transfer of the Proximal Part of the Fibula for Osseous Overgrowth in Children with Congenital or Acquired Tibial Amputation by Graham T. Fedorak, Hugh G. Watts, Anna V. Cuomo, Julian P. Ballesteros, Heather J. Grant, Richard E. Bowen, and Anthony A. Scaduto J Bone Joint Surg Am Volume 97(7): April 1, 2015 ©2015 by The Journal of Bone and Joint Surgery, Inc.

2 Preoperative clinical appearance of terminal overgrowth.
Graham T. Fedorak et al. J Bone Joint Surg Am 2015;97: ©2015 by The Journal of Bone and Joint Surgery, Inc.

3 Representative preoperative radiograph.
Representative preoperative radiograph. Although both the tibia and the fibula have overgrowth, the superficial nature of the tibia makes it the most common site of pain due to overgrowth. Graham T. Fedorak et al. J Bone Joint Surg Am 2015;97: ©2015 by The Journal of Bone and Joint Surgery, Inc.

4 Resection of the tapered tibia and fibula.
Graham T. Fedorak et al. J Bone Joint Surg Am 2015;97: ©2015 by The Journal of Bone and Joint Surgery, Inc.

5 Elevated periosteal flaps.
Graham T. Fedorak et al. J Bone Joint Surg Am 2015;97: ©2015 by The Journal of Bone and Joint Surgery, Inc.

6 Fibular harvest can be done via one incision or two, depending on the length of the residual limb.
Fibular harvest can be done via one incision or two, depending on the length of the residual limb. The peroneal nerve is preserved to avoid neuroma formation. The entire head and metaphysis of the fibula are removed. In this photograph, the structure that is tagged (for educational purposes only) is the lateral collateral ligament. It is not repaired down to the tibia. Graham T. Fedorak et al. J Bone Joint Surg Am 2015;97: ©2015 by The Journal of Bone and Joint Surgery, Inc.

7 Insertion of the osteocartilaginous fibular graft into the tibia.
Graham T. Fedorak et al. J Bone Joint Surg Am 2015;97: ©2015 by The Journal of Bone and Joint Surgery, Inc.

8 The metaphyseal flare of the fibula ensures a tight fit.
The metaphyseal flare of the fibula ensures a tight fit. The periosteum is sutured to the epiphysis. Graham T. Fedorak et al. J Bone Joint Surg Am 2015;97: ©2015 by The Journal of Bone and Joint Surgery, Inc.

9 Postoperative radiograph.
Graham T. Fedorak et al. J Bone Joint Surg Am 2015;97: ©2015 by The Journal of Bone and Joint Surgery, Inc.

10 Kaplan-Meier survival curve for the proportion of patients without revision for overgrowth.
Graham T. Fedorak et al. J Bone Joint Surg Am 2015;97: ©2015 by The Journal of Bone and Joint Surgery, Inc.

11 Kaplan-Meier survival curve for the proportion of patients without repeat surgery for any reason.
Graham T. Fedorak et al. J Bone Joint Surg Am 2015;97: ©2015 by The Journal of Bone and Joint Surgery, Inc.

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