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. 2024 May 22:16:153-162.
doi: 10.2147/ORR.S459927. eCollection 2024.

Remodeling of the Fibula Stump After Transtibial Amputation

Viktor Shevchuk  1 , Yurii Bezsmertnyi  1 , Olexander Branitsky  1 , Dmytro Bondarenko  1 , Olexander Bezsmertnyi  1
Affiliations

Remodeling of the Fibula Stump After Transtibial Amputation

Viktor Shevchuk et al. Orthop Res Rev. .

Abstract

Aim: To study the peculiarities of peroneal stump remodelling after transtibial amputation in the process of prosthesis usage.

Material and methods: A histological study of the ends of the stumps of the fibula in 68 patients was performed. Terms after amputation: 2-8 years.

Results: In the 1st group the stumps with the reparative process completion were formed. In the 2nd group there were sharp disturbances of the reparative process with the formation of the cone-shaped end. In the 3rd group there was a pronounced periosteal bone formation with changes in the shape and structure of bone tissue and incompleteness of the reparative process.

Conclusion: Absence of balloting of the fibula stump and dense overlapping of the medullary cavity by muscles promotes complete remodelling of the fibula remnant with preservation of its organicity. Pathological remodelling of the fibula stump occurs due to its hypermobility, repeated traumatisation of the forming regenerate, neuritis of the peroneal nerve, osteogenesis disorders and structural and functional mismatch of the bone tissue to the loading conditions in the prosthesis. Morphological signs of pathological remodelling are the lack of completion of reparative regeneration, intensive bone tissue remodelling lasting for years with pronounced resorption and appearance of immature bone structures, fractures of the cortical diaphyseal layer, residual limb deformities with formation of a functional regenerates, narrowing and closure of the medullary canal with conglomerate with soft tissue inclusions. The anatomical inferiority of bone tissue formed in the process of remodelling of the fibula remnant creates a threat of stress fracture.

Keywords: balloting; fibula stump; pathological remodeling; transtibial amputation.

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Conflict of interest statement

The authors report no conflicts of interest in this work.

Figures

Figure 1
Figure 1
Histotopograms of peroneal stump ends (haematoxylin and eosin staining. x2.5): (A) Cylindrical shape with formation of bone closure plate from mature bone tissue; (B) Cone-shaped with congestion of the medullary canal (a) and a small periosteal regenerate (b); (C) Cone-shaped with occlusion of the medullary canal (a), violation of the integrity of the cortical diaphyseal layer (arrow); (D) Club-shaped with full length occlusion of the medullary canal with dense fibrous tissue (a), endosteal-periosteal regenerate at the end (b); (E) Club-shaped: resorption of the cortical diaphyseal plate and its replacement by endosteal-periosteal regenerate (a); endosteal bone beams (b); spongy cortical diaphyseal plate in the proximal region (c); fibrous cartilaginous tissue edging the end of the stump (d).
Figure 2
Figure 2
Microphotograph. Dystrophic changes and necrosis of bone tissue. Haematoxylin and eosin staining. x120.
Figure 3
Figure 3
Мicrophotograph. Spongy tissue of periosteal regenerate bordered by hyaline cartilage. Haematoxylin and eosin staining. x90.
Figure 4
Figure 4
Microphotograph. Dissolution of bone beams of cancellous bone (a) bone-cartilaginous regenerate and its replacement by fibrous tissue (b). Haematoxylin and eosin staining. x130.
Figure 5
Figure 5
Microphotograph. An area of active osteoclastic resorption of compact bone. Haematoxylin and eosin staining. x120.
Figure 6
Figure 6
Microphotograph. Resorption of compact bone tissue. Full blood vessels. Haematoxylin and eosin staining. x80.
See this image and copyright information in PMC

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