Vascularised fibular graft for the treatment of congenital pseudarthrosis of the tibia: long-term complications in the donor leg

Abstract

Treatment of congenital pseudarthrosis of the tibia is still controversial, and vascularised fibula graft is a reliable method for consolidation, although complications can occur in the donor leg after fibula grafting. This study evaluates 16 patients with congenital pseudarthrosis of the tibia (CPT) treated with contralateral fibular graft, with regard to complications in the donor leg, and assesses the influence of distal tibiofibular joint arthrodesis in these complications. All patients with CPT were consecutively submitted to surgical treatment with contralateral fibular graft. The mean follow-up was 94 months, varying from 44 to 162 months. The long-term effects in the donor leg were determined, and 12 cases with distal tibiofibular arthrodesis (group 1) were compared with a group without arthrodesis (group 2). Half of the patients had proximal migration of the lateral malleolus. Eight patients had ankle valgus. Group 1 had an average valgus tilt angle of 5.8°, while group 2 had an average angle of 1.5°. There was no significant difference between the patients with or without distal tibiofibular joint arthrodesis. The patients with a distal fibula remnant smaller than 5 cm had greater valgus tilt angle measurements. Distal tibiofibular arthrodesis was not effective in preventing all the complications in the donor leg; however, it can lessen the severity of the complications. Our results show that a distal fibular remnant greater than 5 cm should be retained to prevent ankle valgus.

Fig. 1

Correlation between the distal fibular remnant length and valgus tilt angle

Fig. 2

Correlation between age and valgus tilt angle

Fig. 3

Case W.S.R., male, 31 months at vascularised fibular graft, ten-year follow-up. a Preoperative radiographs. b Immediate postoperative. c Consolidation of distal tibiofibular arthrodesis with mild proximal migration of lateral malleolus and 12° valgus tilt angle. d Ten-year postoperative radiographs showing mild leg length discrepancy

Fig. 4

Case V.A.G., male, 81 months at vascularised fibular graft, 11-year follow-up. a Preoperative radiographs. b Postoperative 1 month. c Eight-years postoperative. d Eleven years postoperative

Fig. 5

Case T.C.S., female, 20 months old at vascularised fibular graft, 13-year follow-up. a Two years postoperative. b Thirteen-year postoperative radiographs. c and d Thirteen-year postoperative clinical evaluation