Anatomical And Clinical Application Of Proximal Reconstruction Of Fibula After Resection Of Distal Radius

Objective: To compare the shape of the articular surface in the fibular head and radius，and provide the anatomical basis for reconstruction of wrist joint with thehead of fibula.Methods: The diameter, circumference and inclination angle of coronal section andsagittal section of all articular surface of the carpal articular surface of theradius and the caput of the fibula in23adults arescent integrity specimenswere measured. The rotated angle of the fibula was measured by radiologicaltechnology to analyze the matching degree from anatomy.Results: Radial internal inclined angle was23.2±1.6degrees, while fibular internalangle is23.7±1.8. There was no significant difference (P>0.05). Radial andfibular backward inclination angle was11.4±1.5,11.6±1.4, there was nosignificant difference (P>0.05). The diameter of coronal section of fibula,lunare and navicular bone was (1.44±0.30) cm,(1.03±0.41) cm,(1.38±0.34)cm, there was significant difference (F＝35.273, P<0.05). The diameter ofvertical section of fibula, lunare and navicular bone was (1.38±0.33) cm,(1.33±0.31) cm,(1.23±0.34) cm, there was significant difference (F＝39.750,P<0.05). The circumference of articular surface of fibula, lunare andnavicular bone was (4.69±0.52) cm,(3.92±0.36) cm,(4.54±0.44) cm, therewas significant difference (F＝4.523, P<0.05). There was significant difference between volar incination of distal radius articular surface androtation angle of all forward inclination of the fibula head (F=368.12,P<0.05),but when the rotation angle was (10~15)°, there was no notable distinction(F=368.12, P>0.05).Conclusion: The fibula head and distal radius articular surface are good matching inshape. Therefore the fibula head can be used to replace the distal radius forthe reconstruction of rediocarpal joint damaged by tumors. The best-rotatedangle is10-15°, matching the actual measurement values of the articularsurface of the distal radius with fibular head, can effectively guide theclinical appropriate selection of distal radial reconstruction. Objective: To investigate the impact of reconstruction of lateral collateral ligament andbiceps femoris on the knee stability after resection of the proximal fibula.Methods: The clinical data were retrospectively analyzed, from13patients with tumorsof the proximal fibula undergoing proximal fibular resections andreconstructions of the lateral collateral ligament and the tendon of thebiceps femoris with anchors from December2007to December2012(treatment group).13patients underwent proximal fibular resection butwere not given reconstruction surgery at the same period as the controlgroup. Lateral stress test was performed after operation; X-ray films weretaken to measure the joint space. Musculoskeletal Tumor Society (MSTS)functional score system was used to evaluate the joint function.Results: The excision length of fibula in treatment group and control group (9.8±1.2)cm,(10.1±1.4) cm, it was not significantly different (t=1.08, P>0.05).X-ray showed that all incisions healed by first intention in2groups. Thepatients in both groups were followed up12to48months, with an averageof25months. One patient with giant cell tumor of the treatment groupdeveloped local recurrence at15months after surgery, and died of systemicmetastases after17months, but had good stability of knee joint. The otherpatients had no recurrence. At last follow-up, the results of knee lateralstress test were negative in the test group, and the joint space increased andwas classed as grade A~B; the results of knee lateral stress test werepositive in the control group, and the joint space was classed as grade D. The MSTS score was96.8±5.3in the test group and85.2±3.7in thecontrol group, showing significant difference (t=2.104, P<0.05).Conclusion: Reconstruction on soft tissues, muscles, and ligaments after resection ofthe proximal fibula is helpful for the recovery of lateral stability of kneejoint, and reconstruction of joint function. Objective: To observe the effectiveness of wrist joint reconstruction with vascularizedfibular head graft after resection of distal radius bone tumor.Methods:23patients with bone tumor of proximal fibula who received treatment in ourhospital from2007.12to2012.12were retrospectively analyzed. All thepatients with were treated with vascularized fibular graft (anastomosis group,n=12) or simple autologous fibular graft (non-anastomosis group, n=11). Allpatients were followed up. The results were graded with Enneking’s systemand evaluated radiographically according to the “International Symposiumon Limb Salvage”. The grade system included limb function, radiologicalexamination and the function of donor site.Results: The patients were followed-up for12to48months, with an average of28months. X-ray showed that all incisions healed by first intention in2groups,and the implanted fibula survived well. Bone healing time ranged from12weeks to17months (mean,13.6weeks). Pain of wrist joints and bonegrafting were not found, deformity and dearticulation did not happened, butthere were different degrees of restricted movement including wrist bending,stretching, and rotating. The wrist joint flexion range: extension35°, flexion35°, radial deviation15°, ulnar deviation25°, pronation20°, supination20°.During follow-up, one patient with GCT developed local recurrence at12months after surgery, and died of systemic metastases after25months. Theother patients had no recurrence. There was significant difference on limbfunction score, recovery and bone healing time between anastomosis group and non-anastomosis group (P<0.05).Conclusion: It is effective for reconstruction of the distal radius replaced by caputfibulae after tumor resection, which not only makes complete resection ofthe tumor tissue, but also can restore the shape of the of carpal tunnelappearance and function radiocarpal joint. Vascularized proximal fibulargraft in reconstructing distal radius bone defect after tumor resection issuperior to without revascularization, which can contribute to rebuild theblood circulation, shorten the bone healing time.