Distal tibial fractures are a poorly recognised complication with fibula free flaps.
The fibula free flap is ideal for complex jaw reconstructions, with low reported donor and flap morbidity. We discuss a distal tibial stress fracture two months following a vascularised fibula free flap procedure. Despite being an unrecognised complication, a literature review produced 13 previous cases; only two were reported in the reconstructive surgery literature, with the most recent claiming to be the first. The majority of these studies treated this fracture non-operatively; none reported their patient follow-up. Each case presented with ipsilateral leg pain, which has been cited as an early donor site morbidity in as many as 40% of fibula free flap cases. It is known that the fibula absorbs at least 15% of leg load on weight bearing. Studies have shown severe valgus deformities in up to 25% of patients with fibulectomies. We treated our patient operatively, first correcting his worsening valgus deformity with an external fixator, then reinforcing his healed fracture with a long distal tibial plate. We believe that this complication is underreported, unexpected and not mentioned during the consenting process. By highlighting the management of our case and the literature, we aim to increase awareness (and thus further reporting and appropriate management) of this debilitating complication.
Norfolk and Norwich University Hospitals NHS Foundation Trust , UK.
A
A
Durst
Norfolk and Norwich University Hospitals NHS Foundation Trust , UK.
J
J
Clibbon
Norfolk and Norwich University Hospitals NHS Foundation Trust , UK.
B
B
Davis
D000230:Adenocarcinoma / Q000601:surgery; D000368:Aged; D016025:Bone Transplantation / Q000009:adverse effects* / Q000379:methods; D005360:Fibula / Q000637:transplantation*; D005592:Fracture Fixation / Q000379:methods; D015775:Fractures, Stress / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery; D058752:Free Tissue Flaps; D006801:Humans; D008297:Male; D008339:Mandibular Neoplasms / Q000601:surgery; D011859:Radiography; D013978:Tibial Fractures / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery; D020858:Tissue and Organ Harvesting / Q000009:adverse effects*
Donor site morbidity; Fibula free flap; Oral cancer; Tibial stress fracture