title: Reverse Transfer of the Proximal Vascularized Fibula to Reconstruct the Lateral Malleolus: A Case Report and Literature Review.
abstract: Defects of the lateral malleolus and distal fibula occur occasionally, mainly because of severe trauma or wide resection of fibular neoplasms. These bony defects should be reconstructed to avoid persistent pain and to prevent an abnormal gait induced by ankle instability. Various methods of repair have been developed, including allografting, autologous iliac crest transplantation, scapular apophysis transplantation, and arthrodesis and prosthetic reconstruction. A reverse transfer of the proximal vascularized fibula is also effective. Its morphologic advantage is apparent, and the surgery is simple and direct, with no need for vascular anastomosis. We treated recurrent fibrous dysplasia in the distal fibula of a young male with wide resection and reconstruction using reverse transfer of the proximal, vascularized fibula. At the 6-year follow-up examination, the patient had an American Orthopaedic Foot and Ankle Society ankle-hindfoot score of 100, without any apparent complications. Additionally, we critically reviewed other methods for reconstructing the lateral malleolus and distal fibula and have concluded that reverse transfer of the proximal vascularized fibula compares favorably and could be the treatment of choice.
authors.affiliation: Orthopedic Surgeon, Department of Orthopedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.
authors.forename: You-Shui
authors.initials: YS
authors.lastname: Gao
authors.affiliation: Professor, Department of Orthopedic Surgery, Sixth People's Hospital of Shanghai Jiao Tong University, Shanghai, China.
authors.forename: Chang-Qing
authors.initials: CQ
authors.lastname: Zhang
authors.affiliation: Professor, Department of Orthopedic Surgery, Sixth People's Hospital of Shanghai Jiao Tong University, Shanghai, China. Electronic address: shengjiagen_ssph@126.com.
authors.forename: Jia-Gen
authors.initials: JG
authors.lastname: Sheng
mesh_terms: D000293:Adolescent; D016512:Ankle Injuries / Q000601:surgery*; D000843:Ankle Joint / Q000000981:diagnostic imaging / Q000601:surgery*; D016025:Bone Transplantation; D002648:Child; D005358:Fibrous Dysplasia, Monostotic / Q000000981:diagnostic imaging / Q000601:surgery*; D005360:Fibula / Q000098:blood supply / Q000000981:diagnostic imaging / Q000637:transplantation*; D006801:Humans; D007593:Joint Instability / Q000601:surgery*; D008297:Male
keywords: distal fibula; fibrous dysplasia; lateral malleolus; vascularized fibula transfer