title: Ipsilateral fibular transfer as a salvage procedure for large traumatic tibial defects in children in an austere environment.
abstract: Large tibial defects present a challenging scenario for the orthopaedic surgeon, particularly in the paediatric patient. Most management options, such as the vascularised fibular graft or Ilizarov technique, require microsurgical techniques or specialist equipment. In an austere environment, acute shortening or limb amputation may be most appropriate. However, limb salvage may be achieved by ipsilateral fibular transfer. In a one-stage operation, the fibular graft is harvested and either placed in the tibial defect in an intramedullary position or secured to the tibia with screws. We present two paediatric cases where this approach was used to preserve the lower limb despite extensive explosive trauma. In the first case, an 11 cm tibial defect was managed with an ipsilateral fibular graft. The graft was placed in an intercalary position proximally, with medial displacement of the ankle and fixation of the fibula as a strut graft. In the second case, a 10 cm tibial defect was managed with an ipsilateral fibular graft, using intercalary placement proximally and distally. Both children returned to weight bearing with crutches within several months of surgery. For large tibial defects, ipsilateral fibular transfer is an effective one-stage operation that represents a viable alternative to amputation in austere environments.
authors.affiliation: Trauma and Orthopaedic Department, Royal Infirmary of Edinburgh, Edinburgh, UK.
authors.forename: Andre J
authors.initials: AJ
authors.lastname: Keenan
authors.affiliation: Trauma and Orthopaedic Department, Royal Infirmary of Edinburgh, Edinburgh, UK.
authors.forename: O J F
authors.initials: OJ
authors.lastname: Keenan
authors.affiliation: Department of Orthopaedics, San Antonio Military Medical Center, San Antonio, Texas, USA.
authors.forename: C
authors.initials: C
authors.lastname: Tubb
authors.affiliation: Trauma and Orthopaedic Department, Institute of Naval Medicine, Gosport, UK.
authors.forename: A
authors.initials: A
authors.lastname: M Wood
authors.affiliation: Department of Orthopaedic and Trauma Surgery, RCDM, Birmingham, UK.
authors.forename: T
authors.initials: T
authors.lastname: Rowlands
authors.affiliation: Orthopaedic and Trauma Surgery, Danish Army, Nuuk, Denmark.
authors.forename: S E
authors.initials: SE
authors.lastname: Christensen
mesh_terms: D055826:Afghan Campaign 2001-; D001753:Blast Injuries / Q000601:surgery*; D016025:Bone Transplantation / Q000379:methods*; D002648:Child; D005107:Explosions; D005360:Fibula / Q000637:transplantation*; D005593:Fracture Fixation, Internal / Q000379:methods*; D006801:Humans; D023821:Limb Salvage / Q000379:methods; D008297:Male; D008887:Military Medicine; D013977:Tibia / Q000601:surgery*; D013978:Tibial Fractures / Q000601:surgery*; D016896:Treatment Outcome
keywords: TRAUMA MANAGEMENT; WOUND MANAGEMENT