Femoral reconstruction by single, folded or double free vascularised fibular grafts

Size: px
Start display at page:

Download "Femoral reconstruction by single, folded or double free vascularised fibular grafts"

Transcription

1 The British Association of Plastic Surgeons (2004) 57, Femoral reconstruction by single, folded or double free vascularised fibular grafts K. Muramatsu*, K. Ihara, M. Shigetomi, S. Kawai Department of Orthopedic Surgery, Yamaguchi University School of Medicine, Minami-Kogushi, Ube, Yamaguchi, Japan Received 3 December 2002; accepted 15 August 2003 KEYWORDS Femur; Fibula; Vascularised bone graft; Stress fracture; Hypertrophic change Summary We reviewed 17 patients for a mean of 25 months period after free vascularised fibular transfer to reconstruct massive bone defect or recalcitrant nonunion of the femur. There were 11 cases of posttraumatic nonunion and six patients had a large bony defect following resection of bone tumour. Ten patients underwent double or folded and seven patients underwent single vascularised fibula graft transfer. Mean bony defect of the femur was 6.5 cm and mean length of grafted fibula was 15 cm. Revision surgery due to postoperative vascular complications was required in five cases. Twenty-three out of 24 (96%) vascularised fibulas were transferred successfully. The resultant outcome was successful in 15 out of 16 (94%) patients with confirmed bone union. Stress fracture occurred in three inlay fibula grafts. Hypertrophic change of the fibula graft was significantly noted in inlay grafts as compared to onlay grafts. All patients could walk without brace at a mean of 11 months postoperatively. Donor-site morbidity was minimum. Vascularised fibula grafting is a reliable and safe reconstructive procedure for massive femur defects. Folded or double fibula grafts cannot prevent stress fractures and the key point is to rigidly stabilise the femur in an anatomically aligned position. Q 2004 The British Association of Plastic Surgeons. Published by Elsevier Ltd. All rights reserved. Free vascularised fibular graft (FVFG) has become an established procedure for the treatment of massive bone defects after bone tumour resection 1,2 and recalcitrant nonunion. 3,4 Fibula is probably the most suitable donor bone for reconstruction of a large defect in a long bone because of its length, geometrical shape and mechanical strength. Of all long bone chronic nonunions, those involving femur are the most disabling and reconstruction with FVFG is favorable in these cases. However, some authors pointed out that *Corresponding author. Tel.: þ ; fax: þ address: muramatu@po.cc.yamaguchi-u.ac.jp FVFG to the femur is technically very difficult with a high rate of immediate and late complications. 4,5 The recipient bone is located deeper than other long bones and has only one major artery. Internal and external bony fixation is very difficult because of the strong muscle forces across the femur. Length discrepancy more than 2 cm of the femur causes gait disturbance. Among them, the most important problem is late stress fracture of FVFG due to low initial mechanical strength. 6,7 Late stress fracture is probably prevented by hypertrophic change of FVFG but until now, to our knowledge, little is known about stress fracture and hypertrophy of FVFG in femur reconstruction. In this study, we reviewed a consecutive series of S /$ - see front matter Q 2004 The British Association of Plastic Surgeons. Published by Elsevier Ltd. All rights reserved. doi: /j.bjps

2 Femoral reconstruction by single, folded or double free vascularised fibular grafts patients after femur reconstruction by FVFG, assessing clinical results and complications. In particular, we focused on the cause of stress fracture and discussed the relationship between mechanical stimulation and hypertrophy of the FVFG. Patients and methods We retrospectively reviewed 17 patients, who underwent FVFG transfer due to a massive bone defect or recalcitrant nonunion of the femur between 1989 and All free fibular transfers were carried out in our university hospital and the follow-up of the patients was subsequently carried out at our outpatient clinic. The mean age of the patients was 39 years (5 74) and the mean followup period was 25 months (6 60). The recorded data of each patient included age, sex, diagnosis, duration of follow up, recipient site, fixation devices, length of bone defect, type of FVFG, graft length, recipient vessels, technique of vascular anastomosis, graft survival, postoperative complications, occurrence of stress fracture, hypertrophic change of FVFG 8 and functional recovery (Table 1). FVFGs were transferred in six cases of posttraumatic nonunion or bone defect without infection, five cases of infected nonunion and six cases of bone defect after tumour resection. Recipient site was the femoral neck in two patients, mid-shaft in six patients and distal femur in nine patients. Skeletal fixation of the femur was performed with a plate and screws in five patients, external fixator in six patients, fibula graft itself in three patients and intramedullary rod in remaining two patients. Single FVFG was transferred in seven patients, double FVFG transfer in seven patients and twin-barreled (folded) FVFG transfer was performed in three patients based on a single vascular pedicle. In cases with double fibula grafting, one was basically placed as inlay (intramedullary) graft and another was used as onlay graft. The knee joints were fused by double FVFGs in two cases. The mean length of bone defect was 6.5 cm (0 15) and the mean length of FVFG was 15 cm (5 25). Supplementary bone grafting with iliac cancellous bone graft was performed in all 17 patients at the junction of femur and fibula graft. The donor peroneal artery was anastomosed according to the level of the recipient site. In eight of the 10 single and folded FVFGs, the peroneal artery was anastomosed to the branch of the femoral artery by endto-end technique and in two cases by end-to-side anastomosis to the femoral artery. In seven cases of femur reconstruction with double FVFGs, seven FVFGs were performed by end-to-side anastomosis to the femoral artery and seven were performed by end-to-end anastomosis to the branch. In most cases, the peroneal veins were anastomosed to the vanae comitantes of the recipient artery and the saphenous vein. The Mann Whitney method was used to compare the variables of two different groups and a p value less than 0.05 was considered to be significant statistically. Results Graft survival A peroneal flap was simultaneously transferred to monitor the survival of the fibula graft in 19 FVFGs and bone scintigram was used in five FVFGs. Five FVFGs (26%) had vascular complications on flap monitoring, necessitating re-exploration within 5 days following the first operation. In three of these cases, the cause was venous thrombosis and in one, arterial thrombosis. After thrombectomy, three flaps survived. One flap had vascular complication due to over-stretching of the perforating vessels and it was removed at the time of re-exploration. In total, 23 out of 24 FVFGs were successfully transferred (96%). Vascular complication had no correlation with selection of the recipient vessels and anastomosis fashion. Rate of union Except in one case (Case 12) with short-term follow-up, 15 of the 16 reconstructed femurs (93%) united primarily following the vascularised fibular transfer. Although exact time of bony union could not be diagnosed on plain radiograph, five femurs united by 6 months, 5 by 1 year and 6 by 2 years. One patient had a residual nonunion of the distal bony junction but weight bearing was possible in this case by using long leg brace. Graft hypertrophy Hypertrophy of the fibular graft was assessed by the modified method of DeBoer (1989) at three levels: proximal third, middle and distal third. An index value of more than 20% was confirmed as graft hypertrophy. In five cases with bony defect less than 1 cm, no hypertrophic change occurred in the transferred onlay graft. Excluding one case (failed vascularised grafting; Case 17), all intercalary

3 552 Table 1 Patients and methods Case Age and sex Diagnosis Follow-up (mos) Site of involvement Fixation Bone defect (cm) FVFG number Length Recipient vessels Anastomosis Result Immediate complication Stress fracture Hypertrophy (%) Prox/Mid/Dis FWB (mos) 1 35M Infected nonunion 24 Mid-shaft IMR 9 Single 15 DFA ETE Survive Infection No 14/16/ F GCT 48 Distal Plate 11 Double 14 In,14 On FA ETS Survive Infection No 54/17/27, 20/0/ F PTN 12 Distal ESF 4 Double 21, 22 FA ETS Survive None No 30/10/8, 8/0/ M PTN 36 Distal Plate 5 Single 10 FA ETE Survive None No 7/9/ M PTN 24 Mid-shaft ESF 7 Folded 13, 13 DFA ETS Survive None No 42/37/32, 17/17/ M PTN 18 Mid-shaft ESF 1 Single 16 FA ETS Survive None No 10/8/ M PTN 18 Distal ESF 7 Double 25, 17 FA ETE Survive None No 32/0/0, 0/0/ M Infected nonunion 48 Neck Fibula 3 Single 10 DFA ETE Survive Infection No 50/50/ F Infected nonunion 24 Neck Fibula 1 Single 5 IGA ETE Survive None No 0/0/ M MFH 24 Mid-shaft IMR 12 Folded 11, 15 DFA ETE Survive None No 50/42/31, 8/0/ F Infected nonunion 12 Mid-shaft Fibula 0 Single 16 On LCA ETE Survive Flap necrosis No 0/0/ M PTN 8 Distal ESF 11 Folded 14, 10 LCA ETE Survive Infection No 30/33/44, 37/22/ F OS 60 Distal Fibula 0 Double 12, 8 M Br ETE Survive Venous thrombus No 0/0/7, 0/0/ M Infected nonunion 31 Distal ESF 0 Double 20, 12 FA ETS Survive Venous thrombus No 0/0/7, 0/7/ M OS 9 Distal Plate 13 Double 16, 16 DGA, M Br ETE Survive Venous thrombus No 0/0/0, 0/0/ M OS 17 Distal Plate 15 Single 18 DGA ETE Survive Nonunion No 113/89/ M GCT 12 Distal Plate 11 Double 22, 22 FA, M Br ETS, ETE Survive necrosis Arterial thrombus No 0/0/0, 0/0/0 9 PTN, posttraumatic nonunion; GCT, giant cell tumour; MFH, malignant fibrous histiocytoma; OS, osteosarcoma; ESF, external skeletal fixator; IMR, intramedullary rod; DFA: deep femoral artery; IGA, inferior gluteal artery; LCA, lateral circumflex artery; M Br, muscle brance; ETE, end-to-end anastomoses; ETS, end-to-side anastomoses; FWB, full weight bearing. K. Muramatsu et al.

4 Femoral reconstruction by single, folded or double free vascularised fibular grafts 553 grafts showed hypertrophy at the final follow-up. There was no statistically significant difference between single grafts (excluding one child case; Case 16, mean ¼ 24.2%) and double or folded grafts (mean ¼ 19.8%) and also between the three levels of the grafted fibula. In six cases with double or folded grafts, significant hypertrophic change occurred in inlay grafts (mean ¼ 28.8%, p ¼ 0:0016) as compared to onlay grafts (mean ¼ 10.7%). Stress fracture We diagnosed a stress fracture seen as a clear fracture line on plain radiographs accompanied with symptoms of localised pain and tenderness. There were stress fractures of the fibula graft in three patients (Case 4, 7, 12) at 10, 10, 12 months postoperatively. All of them healed uneventfully with conservative treatment. All three cases had undergone intercalary double or folded fibula grafting and the grafted fibulas showed hypertrophic change at occurrence of stress fracture. These femur and fibula grafts had angular deformity of 15, 18 and 30 degrees. There was no occurrence of stress fracture in onlay fibula grafts and in cases with angular deformity less than 15 degrees. Time of full weight bearing The time until the patient could walk without braces ranged from four to 24 months (mean ¼ 11 months). There was no significant difference between single fibula transfer cases (mean ¼ 11 months) and double or folded fibula transfer cases (mean ¼ 11 months). On an average, the time of full weight bearing was delayed to 16 months postoperatively in four cases with residual osteomyelitis. In five cases with minimum bone defect and onlay fibula grafting, weight bearing of the affected limb was faster (mean ¼ 8 months) compared to that of intercalary graft cases (mean ¼ 12 months). Complications Four out of five cases with infectious nonunion of the femur had residual localized infection, but all of them healed slowly after debridement and curettage of recurring osteomyelitis and wound care. Two patients had iliac bone grafting for a second time at the junction of the femur and fibula graft. There was no local recurrence of malignant bone tumour. There were no donor-site wound complications and none of the patients perceived serious functional impairment of the donor limb. The clinical record did not suggest any objective findings of an abnormal nature related to the donor limb. Case report A 23-year-old man with a malignant fibrous histiocytoma of the left femur shaft was treated by extensive excision and the resultant 12 cm femur defect was reconstructed by a 26 cm long folded fibula graft (Fig. 1(A) (C)). After the residual femur was anatomically fixed by intramedullar interlocking rod, an 11 cm long fibula graft was placed intramedullary (inlay graft) and 15 cm fibula graft was used as onlay graft. The peroneal vessels were anastomosed to deep femoral vessels in an end-toend fashion. The monitoring peroneal flap survived without any vascular complications. Inlay fibula graft showed remarkable hypertrophy at all levels but onlay graft showed slight hypertrophy. Bony union at both junctions was achieved within 6 months postoperatively. Full weight bearing was permitted 7 months after operation and no stress fracture occurred thereafter. At the follow-up of 2 years, the patient returned to his original employment. Discussion Large femur defects resulting from bone tumours or infectious nonunion present a reconstructive challenge for today s orthopaedic surgeon. Available reconstructive methods have their limitations. The role of free bone tissue transfer for reconstruction of difficult long bone defects has been well recognized. 9,10 Among several options of donor source, fibula graft is probably the most suitable for femur reconstruction because of its structure and minimum donor-site morbidity. In our series, none of the patients perceived functional impairment of the donor limb. Our results of overall union rate of 93% are favorable as compared to other reports. Wood (1990) 4 reported femoral reconstruction by FVFG and 69% of patients healed primarily and 83% of patients achieved bony union following secondary surgery. Hsu et al. (1997) 1 reported FVFG reconstruction after tumour resection and bony union was achieved in 90% of cases at an average of 7.6 months postoperatively. Yajima et al. (1993) 5 also demonstrated high union rate of 95% at an average of 6.4 months after surgery in their cases. Our results also support that FVFG is reliable and stable procedure for the femur reconstruction.

5 554 K. Muramatsu et al. Figure 1 (Case 10) A 23-year-old man with a malignant fibrous histiocytoma of the left femur shaft. (A) One month postoperatively. After the residual femur was anatomically fixed by intramedullar interlocking rod, 12 cm femur defect was reconstructed by a 26 cm long folded fibula graft. (B) One year postoperatively. Bony union at both junctions was achieved within 6 months postoperatively. Inlay fibula graft showed remarkable hypertrophy at all levels but onlay graft showed slight hypertrophy. (C) Two years postoperatively. Intramedullar interlocking rod was removed without any complication. One of the advantageous phenomena of a vascularised fibula transfer is its ability to hypertrophy. 11 Although the cause of satisfactory hypertrophy is not completely understood, our higher incidence of graft hypertrophy was probably related to the mechanical stimulation due to weight bearing. 12,13 In this series, the intercalary inlay graft showed remarkable hypertrophy as compared to the onlay non-weight-bearing fibula. Interestingly, in the cases with double or folded fibula transfer, inlay graft showed significant hypertrophy compared to onlay graft. These results clearly demonstrated that hypertrophy of fibula graft is associated with mechanical stimulation caused by weight bearing. Femur reconstruction by vascularised fibula graft also has some problems. One of the problems is that this procedure is technically demanding. 5 The femur is located deeper than other long bones and has few main vessels suitable for microsurgical anastomosis. Monitoring of graft vascularity is troublesome because of the inability of the monitoring peroneal flap to reach the skin surface in some cases. In our results, the survival rate of the fibula graft was favorable in 96% of cases (23/24 fibulas). In the literature, there are few papers, which clearly confirm graft survival. Yajima et al. (1993) 5 reported that grafting was successful in 19 out of 20 patients (95%). Vascular complication occurred more frequently at the venous anastomosis site than at the arterial site. We suppose that an important factor for graft survival is not the selection of the artery and anastomosis fashion but selection of recipient vein. Careful postoperative observation of the monitoring flap and immediate re-exploration in complicated cases are also important factors. A second problem is the low mechanical strength of the fibula graft. Some authors presented a late stress fracture of grafted fibula and its reported rate is around 10% (7 16%). 5,7 Stress fracture causes delayed weight bearing of the affected limb. To resolve this problem, we have attempted double or folded vascularised fibula graft in cases with extensive femur defect. However, our results showed that stress fracture could not be prevented by using two fibulas. Interestingly, hypertrophic change was not significantly different between single and double grafts. In the case with double fibula grafting, one is fixed as inlay graft, that mainly supports weight bearing and another as onlay graft that works only as additional support. We believe that the key factor to prevent stress fracture is holding the femur in anatomical alignment using a proper fixation device. Our three cases with stress facture had undergone double fibula graft transfer and the femur had angular deformity more than 15 degrees. If the femur was stabilised in proper alignment, there would have been no cases of stress fracture even with a single fibula graft.

6 Femoral reconstruction by single, folded or double free vascularised fibular grafts 555 A third problem is prolonged time to full weight bearing. All patients could walk without long leg braces at final follow-up but it took a period of 11 months an average after fibula graft transfer. Yajima (1993) 5 recommended a telescoping external fixator to gradually stress the fibula graft and stimulate hypertrophy. Although we have no experience of this external fixator, rigid internal fixation using intermedullary interlocking nail or supracondylar plate may be helpful to prevent stress fracture and allow early weight bearing on the affected limb. Although there was a high rate of complications involving postoperative venous embolism or late stress fracture in our series, most of them resolved without greatly influencing the final outcome. We cannot conclude that free vascularised fibula graft is the best option for femur reconstruction, as we have no experience with alternative methods of treatment, such as bone transport method. However, in our series, FVFG transfer proved to be a reliable and safe procedure for femur reconstruction. References 1. Hsu RW, Wood MB, Sim FH, Chao EY. Free vascularised fibular grafting for reconstruction after tumour resection. J Bone Joint Surg 1997;79B: Ihara K, Doi K, Yamamoto M, Kawai S. Free vascularized fibular grafts for large bone defects in the extremities after tumor excision. J Reconstr Microsurg 1998;14: Duffy GP, Wood MB, Rock MG, Sim FH. Vascularized free fibular transfer combined with autografting for the management of fracture nonunions associated with radiation therapy. J Bone Joint Surg 2000;82A: Wood MB. Femoral reconstruction by vascularized bone transfer. Microsurgery 1990;11: Yajima H, Tamai S, Mizumoto S, Ono H. Vascularised fibular grafts for reconstruction of the femur. J Bone Joint Surg 1993;75B: O Brien BM, Gumley GJ, Dooley BJ, Pribaz JJ. Folded free vascularized fibula transfer. Plast Reconstr Surg 1988;82: Hou SM, Liu TK. Reconstruction of skeletal defects in the femur with two-strut free vascularized fibular grafts. J Trauma 1992;33: de Boer HH, Wood MB. Bone changes in the vascularised fibular graft. J Bone Joint Surg 1989;71B: Jupiter JB, Bour CJ, May Jr JW. The reconstruction of defects in the femoral shaft with vascularized transfers of fibular bone. J Bone Joint Surg 1987;69A: Weiland AJ, Daniel RK. Microvascular anastomoses for bone grafts in the treatment of massive defects in bone. J Bone Joint Surg 1979;61A: Tu YK, Yen CY, Yeh WL, Wang IC, Wang KC, Ueng WN. Reconstruction of posttraumatic long bone defect with free vascularized bone graft: good outcome in 48 patients with 6 years follow-up. Acta Orthop Scand 2001;72: Mizumoto S, Tamai S, Goshima J, Yajima H, Yoshii T, Fukui A, Masuhara K. Experimental study of vascularized tibiofibula graft in inbred rats: a preliminary report. J Reconstr Microsurg 1986;3: Muramatsu K, Bishop AT. Cell repopulation in vascularized bone grafts. J Orthop Res 2002;20:772 8.

Reconstruction of Massive Femur Defect with Free Vascularized Fibula Graft Following Tumor Resection

Reconstruction of Massive Femur Defect with Free Vascularized Fibula Graft Following Tumor Resection Reconstruction of Massive Femur Defect with Free Vascularized Fibula Graft Following Tumor Resection KEIICHI MURAMATSU 1, KOICHIRO IHARA 2, KAZUTERU DOI 3, MITSUNORI SHIGETOMI 1, TAKAHIRO HASHIMOTO 1 and

More information

ARMS. Reconstruction of Large Femur and Tibia Defect with Free Vascularized Fibula Graft and Locking Plate INTRODUCTION.

ARMS. Reconstruction of Large Femur and Tibia Defect with Free Vascularized Fibula Graft and Locking Plate INTRODUCTION. Original Article ARMS Archieves of Reconstructive Microsurgery pissn 2383-5257 eissn 2288-6184 Arch Reconstr Microsurg 2015;24(2):68-74 http://dx.doi.org/10.15596/arms.2015.24.2.68 Reconstruction of Large

More information

Title: An intramedullary free vascularized fibular graft combined with pasteurized

Title: An intramedullary free vascularized fibular graft combined with pasteurized Title: An intramedullary free vascularized fibular graft combined with pasteurized autologous bone graft in leg reconstruction for patients with osteosarcoma Names of authors Masataka Noguchi, Hiroo Mizobuchi,

More information

Treatment of non-union of forearm bones with a free vascularised cortico - periosteal flap from the medial femoral condyle

Treatment of non-union of forearm bones with a free vascularised cortico - periosteal flap from the medial femoral condyle Acta Orthop. Belg., 2009, 75, 611-615 ORIGINAL STUDY Treatment of non-union of forearm bones with a free vascularised cortico - periosteal flap from the medial femoral condyle Luc DE SMET From the University

More information

Free vascularized fibular graft for tibial pseudarthrosis in neurofibromatosis

Free vascularized fibular graft for tibial pseudarthrosis in neurofibromatosis Acta Orthop Scand 1988;59(4):425-429 Free vascularized fibular graft for tibial pseudarthrosis in neurofibromatosis 03 17878 1 luli lrl Herman H. de Boer', Abraham J. Verbout', Hans K. L. Nielsen2 and

More information

Fibula bone grafting in infected gap non union: A prospective case series

Fibula bone grafting in infected gap non union: A prospective case series 2019; 3(1): 06-10 ISSN (P): 2521-3466 ISSN (E): 2521-3474 Clinical Orthopaedics www.orthoresearchjournal.com 2019; 3(1): 06-10 Received: 03-11-2018 Accepted: 06-12-2018 Dr. Mohammed Nazim M.S (Ortho),

More information

The gastrocnemius with soleus bi-muscle flap

The gastrocnemius with soleus bi-muscle flap The British Association of Plastic Surgeons (2004) 57, 77 82 The gastrocnemius with soleus bi-muscle flap Ikuo Hyodo a, *, Bin Nakayama b, Mitsuru Takahashi c, Kazuhiro Toriyama d, Yuzuru Kamei d, Shuhei

More information

The earlier clinic experience of the reverse-flow anterolateral thigh island flap

The earlier clinic experience of the reverse-flow anterolateral thigh island flap British Journal of Plastic Surgery (2005) 58, 160 164 The earlier clinic experience of the reverse-flow anterolateral thigh island flap Gang Zhou, Qi-Xu Zhang*, Guang-Yu Chen Scar Multiple Treatment Centre,

More information

Wrist Joint Reconstruction With a Vascularized Fibula Free Flap Following Giant Cell Tumor Excision in the Distal Radius

Wrist Joint Reconstruction With a Vascularized Fibula Free Flap Following Giant Cell Tumor Excision in the Distal Radius Wrist Joint Reconstruction With a Vascularized Fibula Free Flap Following Giant Cell Tumor Excision in the Distal Radius Chester J. Mays, BS, a Kyle Ver Steeg, MD, a Saeed Chowdhry, MD, b David Seligson,

More information

The ipsilateral and contralateral fibulae have been

The ipsilateral and contralateral fibulae have been Ipsilateral vascularised fibular transport for massive defects of the tibia R. M. Atkins, P. Madhavan, J. Sudhakar, D. Whitwell From the Bristol Royal Infirmary, Bristol, England The ipsilateral and contralateral

More information

Intercalary Femur and Tibia Segmental Allografts Provide an Acceptable Alternative in Reconstructing Tumor Resections

Intercalary Femur and Tibia Segmental Allografts Provide an Acceptable Alternative in Reconstructing Tumor Resections CLINICAL ORTHOPAEDICS AND RELATED RESEARCH Number 426, pp. 97 102 2004 Lippincott Williams & Wilkins Intercalary Femur and Tibia Segmental Allografts Provide an Acceptable Alternative in Reconstructing

More information

Management of a large post-traumatic skin and bone defect using an Ilizarov frame

Management of a large post-traumatic skin and bone defect using an Ilizarov frame Acta Orthop. Belg., 2006, 72, 214-218 TECHNICAL NOTE Management of a large post-traumatic skin and bone defect using an Ilizarov frame Pieter D HOOGHE, Koen DEFOORT, Johan LAMMENS, Jos STUYCK From the

More information

Vascularised free fibular flap in bone resection and reconstruction *

Vascularised free fibular flap in bone resection and reconstruction * British Journal of Plastic Surgery (2005) 58, 425 430 Vascularised free fibular flap in bone resection and reconstruction * P.J. Belt*, I.C. Dickinson, D.R.B. Theile Department of Plastic and Reconstructive

More information

CASE REPORT. Bone transport utilizing the PRECICE Intramedullary Nail for an infected nonunion in the distal femur

CASE REPORT. Bone transport utilizing the PRECICE Intramedullary Nail for an infected nonunion in the distal femur PRODUCTS CASE REPORT Bone transport utilizing the PRECICE Intramedullary Nail for an infected nonunion in the distal femur Robert D. Fitch, M.D. Duke University Health System 1 1 CONDITION Infected nonunion

More information

Debate: I Do Bone Transport. Disclosures. Bone Defects 5/10/2017

Debate: I Do Bone Transport. Disclosures. Bone Defects 5/10/2017 Debate: I Do Bone Transport David W. Lowenberg, M.D. Clinical Pressor Department Orthopaedic Surgery Stanford University School Medicine Disclosures Board Directors: Foundation for Orthopaedic Trauma (FOT)

More information

CHAPTER 16 LOWER EXTREMITY. Amanda K Silva, MD and Warren Ellsworth, MD, FACS

CHAPTER 16 LOWER EXTREMITY. Amanda K Silva, MD and Warren Ellsworth, MD, FACS CHAPTER 16 LOWER EXTREMITY Amanda K Silva, MD and Warren Ellsworth, MD, FACS The plastic and reconstructive surgeon is often called upon to treat many wound problems of the lower extremity. These include

More information

The long term fate of the fibula when used as an intraosseous graft

The long term fate of the fibula when used as an intraosseous graft Acta Orthop. Belg., 2004, 70, 322-326 The long term fate of the fibula when used as an intraosseous graft Onkar N. NAGI, Mandeep S. DHILLON, Sameer AGGARWAL From the Post Graduate Institute of Medical

More information

Vascularized Bone Graft for Oncological Reconstruction of the Extremities: Review of the Biological Advantages

Vascularized Bone Graft for Oncological Reconstruction of the Extremities: Review of the Biological Advantages Review Vascularized Bone Graft for Oncological Reconstruction of the Extremities: Review of the Biological Advantages KEIICHI MURAMATSU, TAKAHIRO HASHIMOTO, YASUHIRO TOMINAGA and TOSHIHIKO TAGUCHI Department

More information

Methods Used for Reconstruction in Aggressive Bone Tumours: An Early Experience

Methods Used for Reconstruction in Aggressive Bone Tumours: An Early Experience ORIGINAL ARTICLE Methods Used for Reconstruction in Aggressive Bone Tumours: An Early Experience K L Pan, FRCS*, S STing, FRCS**, A W K Mohamad, MS (Orth)*, W GLee, FRCS**, C C Wong, FRCS**, A H Rasit,

More information

DESCENDING BRANCH OF THE LATERAL CIRCUMFLEX FEMORAL ARTERY AS A RECIPIENT VESSEL FOR VASCULARIZED FIBULAR GRAFTS: CLINICAL CASE SERIES

DESCENDING BRANCH OF THE LATERAL CIRCUMFLEX FEMORAL ARTERY AS A RECIPIENT VESSEL FOR VASCULARIZED FIBULAR GRAFTS: CLINICAL CASE SERIES DESCENDING BRANCH OF THE LATERAL CIRCUMFLEX FEMORAL ARTERY AS A RECIPIENT VESSEL FOR VASCULARIZED FIBULAR GRAFTS: CLINICAL CASE SERIES GOKHAN MERIC, M.D., 1 ALI ENGIN ULUSAL, M.D., 1 AZIZ ATIK, M.D., 1

More information

EXPERT TIBIAL NAIL PROTECT

EXPERT TIBIAL NAIL PROTECT EXPERT TIBIAL NAIL PROTECT Enhance your first line of defense This publication is not intended for distribution in the USA. CLINICAL EVIDENCE CONTENT AUTHOR TITLE OF CHAPTER PAGE ETN PROtect clinical evidence

More information

.org. Tibia (Shinbone) Shaft Fractures. Anatomy. Types of Tibial Shaft Fractures

.org. Tibia (Shinbone) Shaft Fractures. Anatomy. Types of Tibial Shaft Fractures Tibia (Shinbone) Shaft Fractures Page ( 1 ) The tibia, or shinbone, is the most common fractured long bone in your body. The long bones include the femur, humerus, tibia, and fibula. A tibial shaft fracture

More information

The Journal of the Korean Society of Fractures Vol.13, No.3, July, 2000

The Journal of the Korean Society of Fractures Vol.13, No.3, July, 2000 The Journal of the Korean Society of Fractures Vol13, No3, July, 2000 2, 3 ) : 40-12, Tel : (02) 966-1616 Fax : (02) 968-2394 E-mail : adkajs@thrunetcom 471 8, 1 2 ) (Table 1) 1 6 14, 2 1 2 1 Ender 29

More information

Treatment of delayed union or non-union of the tibial shaft with partial fibulectomy and an Ilizarov frame

Treatment of delayed union or non-union of the tibial shaft with partial fibulectomy and an Ilizarov frame Acta Orthop. Belg., 2007, 73, 630-634 ORIGINAL STUDY Treatment of delayed union or non-union of the tibial shaft with partial fibulectomy and an Ilizarov frame Jo DUJARDYN, Johan LAMMENS From the University

More information

Novel Interpositional Vein Grafting for Pedicle Extension of Island Pedicle Flaps

Novel Interpositional Vein Grafting for Pedicle Extension of Island Pedicle Flaps e50 Case Report THIEME Novel Interpositional Vein Grafting for Pedicle Extension of Island Pedicle Flaps Shuhei Yoshida, MD 1 Isao Koshima, MD 1 Shogo Nagamatsu, MD 2 Kazunori Yokota, MD 2 Shuji Yamashita,

More information

Metastatic Disease of the Proximal Femur

Metastatic Disease of the Proximal Femur CASE REPORT Metastatic Disease of the Proximal Femur WI Faisham, M.Med{Ortho)*, W Zulmi, M.S{Ortho)*, B M Biswal, MBBS** 'Department of Orthopaedic, "Department of Oncology and Radiotherapy, School of

More information

Role of free tissue transfer in management of chronic venous ulcer

Role of free tissue transfer in management of chronic venous ulcer Original Article Role of free tissue transfer in management of chronic venous ulcer K. Murali Mohan Reddy, D. Mukunda Reddy Department of Plastic Surgery, Nizams Institute of Medical Sciences, India. Address

More information

Surgical interventions in chronic osteomyelitis

Surgical interventions in chronic osteomyelitis Kathmandu University Medical Journal (2005) Vol. 3, No. 1, Issue 9, 50-54 Surgical interventions in chronic osteomyelitis Shrestha BK 1, Rajbhandary T 2, Bijukachhe B 2, Banskota AK 3 1 Associate Professor,

More information

Is Distraction Histiogenesis a Reliable Method to Reconstruct Segmental Bone and Acquired Leg Length Discrepancy in Tibia Fractures and Non Unions?

Is Distraction Histiogenesis a Reliable Method to Reconstruct Segmental Bone and Acquired Leg Length Discrepancy in Tibia Fractures and Non Unions? Is Distraction Histiogenesis a Reliable Method to Reconstruct Segmental Bone and Acquired Leg Length Discrepancy in Tibia Fractures and Non Unions? James J Hutson Jr MD Professor Orthopedic Trauma Ryder

More information

Gastrocnemius Muscle Flap Coverage of Chronically= Infected Knee Joints

Gastrocnemius Muscle Flap Coverage of Chronically= Infected Knee Joints Gastrocnemius Muscle Flap Coverage of Chronically= Infected Knee Joints ABSTRACT Chronically infected open knee joints present dif cult problem. Aggressive debridement of chronically infected soft tissue

More information

Giant Cell Tumour of the Distal Radius: Wide Resection and Reconstruction by Non-vascularised Proximal Fibular Autograft

Giant Cell Tumour of the Distal Radius: Wide Resection and Reconstruction by Non-vascularised Proximal Fibular Autograft 900 Original Article Giant Cell Tumour of the Distal Radius: Wide Resection and Reconstruction by Non-vascularised Proximal Fibular Autograft Ayman Abdelaziz Bassiony, 1 MD Abstract Introduction: Giant

More information

JOURNALOF ORTHOPAEDIC TRAUMA

JOURNALOF ORTHOPAEDIC TRAUMA JOT Special Case Report Series CASE REPORTS www.jorthotrauma.com JOURNALOF ORTHOPAEDIC TRAUMA OFFICIAL JOURNAL OF Orthopaedic Trauma Association Belgian Orthopaedic Trauma Association Canadian Orthopaedic

More information

USE OF THE IPSILATERAL VASCULARISED FIBULA FOR

USE OF THE IPSILATERAL VASCULARISED FIBULA FOR USE OF THE IPSILATERAL VASCULARISED FIBULA FOR TIBIAL RECONSTRUCTION R. HERTEL, M. PISAN, R. P. JAKOB From the University of Berne, Switzerland Between 1989 and 1994 we used a vascularised ipsilateral

More information

Pedicled Fillet of Leg Flap for Extensive Pressure Sore Coverage

Pedicled Fillet of Leg Flap for Extensive Pressure Sore Coverage Pedicled Fillet of Leg Flap for Extensive Pressure Sore Coverage Shareef Jandali, MD, and David W. Low, MD Division of Plastic Surgery, University of Pennsylvania Health System, Philadelphia Correspondence:

More information

CASE REPORT Omentum Free Flap Anastomosed to Arterial Bypass in Open Knee Dislocation: Case Report and Discussion

CASE REPORT Omentum Free Flap Anastomosed to Arterial Bypass in Open Knee Dislocation: Case Report and Discussion CASE REPORT Omentum Free Flap Anastomosed to Arterial Bypass in Open Knee Dislocation: Case Report and Discussion Julien Pauchot, MD, PhD, a Emilie Ducroux, MD, b Grégoire Leclerc, MD, a Laurent Obert,

More information

PUT YOUR BEST FOOT FORWARD

PUT YOUR BEST FOOT FORWARD PUT YOUR BEST FOOT FORWARD Bala Ramanan, MBBS 1 st year vascular surgery fellow Introduction The epidemic of diabetes and ageing of our population ensures critical limb ischemia will continue to grow.

More information

BONE TRANSPLANTATION IN LIMB SAVING SURGERIES: THE PHILIPPINE EXPERIENCE

BONE TRANSPLANTATION IN LIMB SAVING SURGERIES: THE PHILIPPINE EXPERIENCE BONE TRANSPLANTATION IN LIMB SAVING SURGERIES: THE PHILIPPINE EXPERIENCE EDWARD HM WANG, MD UP-Musculoskeletal Tumor Unit and Tissue & Bone Bank Dept. of Orthopedics University of the Philippines-Philippine

More information

Surgical Management of aseptic Femoral Shaft Non-union after Intramedullary Fixation

Surgical Management of aseptic Femoral Shaft Non-union after Intramedullary Fixation The Egyptian Journal of Hospital Medicine (July 2018) Vol. 72 (7), Page 4946-4950 Surgical Management of aseptic Femoral Shaft Non-union after Intramedullary Fixation Eissa Ragheb Refaie 1, Ahmed Abd El

More information

Reconstructive treatment following resection of high-grade soft-tissue sarcomas of the lower limb

Reconstructive treatment following resection of high-grade soft-tissue sarcomas of the lower limb Journal of Orthopaedic Surgery 2005;13(1):58-63 Reconstructive treatment following resection of high-grade soft-tissue sarcomas of the lower limb AM Leow, AS Halim Reconstructive Sciences Department, Hospital

More information

Reintroducing the latissimus-rib free flap as a long bone substitute in the reconstruction of lower extremity injuries

Reintroducing the latissimus-rib free flap as a long bone substitute in the reconstruction of lower extremity injuries Case report Medical Journal of the Islamic Republic of Iran.Vol. 22, No. 2, August 2008. pp.104-110 Reintroducing the latissimus-rib free flap as a long bone substitute in the reconstruction of lower extremity

More information

Anatomical relationship between arteries and veins in the paraumbilical region q

Anatomical relationship between arteries and veins in the paraumbilical region q The British Association of Plastic Surgeons (2003) 56, 552 556 Anatomical relationship between arteries and veins in the paraumbilical region q N. Imanishi a, *, H. Nakajima b, T. Minabe c, H. Chang d,

More information

Management for Postoperative Infection of Fractures

Management for Postoperative Infection of Fractures The Journal of the Korean Society of Fractures Vol12, No2, April, 1999 = Abstract = Management for Postoperative Infection of Fractures Eui-Hwan Ahn, MD, In-Whan Chung, MD, Jeong-Hwan Oh, MD, Seong-Tae

More information

Use Of A Long Femoral Stem In The Treatment Of Proximal Femoral Fractures: A Report Of Four Cases

Use Of A Long Femoral Stem In The Treatment Of Proximal Femoral Fractures: A Report Of Four Cases ISPUB.COM The Internet Journal of Orthopedic Surgery Volume 5 Number 1 Use Of A Long Femoral Stem In The Treatment Of Proximal Femoral Fractures: A Report Of Four Cases C Yu, V Singh Citation C Yu, V Singh..

More information

ILIZAROV TECHNIQUE IN CORRECTING LIMBS DEFORMITIES: PRELIMINARY RESULTS

ILIZAROV TECHNIQUE IN CORRECTING LIMBS DEFORMITIES: PRELIMINARY RESULTS Bahrain Medical Bulletin, Volume 17, Number 2, June 1995 Original ILIZAROV TECHNIQUE IN CORRECTING LIMBS DEFORMITIES: PRELIMINARY RESULTS Saleh W. Al-Harby, FRCS(Glasg)* This is a prospective study of

More information

Use of internal callus distraction in the treatment of congenital brachymetatarsia

Use of internal callus distraction in the treatment of congenital brachymetatarsia British Journal of Plastic Surgery (2005) 58, 1014 1019 CASE REPORT Use of internal callus distraction in the treatment of congenital brachymetatarsia Naoto Yamada*, Yoshihiro Yasuda, Nobuko Hashimoto,

More information

Simultaneous reconstruction of the bone and vessels for complex femoral defect

Simultaneous reconstruction of the bone and vessels for complex femoral defect Miyamoto et al. World Journal of Surgical Oncology (2016) 14:291 DOI 10.1186/s12957-016-1037-8 CASE REPORT Open Access Simultaneous reconstruction of the bone and vessels for complex femoral defect Shimpei

More information

Reconstruction of a Maxillary Oncologic Defect with a Fibula Osteocutaneous Flap. Using Synthes ProPlan CMF and the MatrixMIDFACE Plating System.

Reconstruction of a Maxillary Oncologic Defect with a Fibula Osteocutaneous Flap. Using Synthes ProPlan CMF and the MatrixMIDFACE Plating System. Case Report Reconstruction of a Maxillary Oncologic Defect with a Fibula Osteocutaneous Flap. Using Synthes ProPlan CMF and the MatrixMIDFACE Plating System. Reconstruction of a Maxillary Oncologic Defect

More information

CASE REPORT. Distal radius nonunion after volar locking plate fixation of a distal radius fracture: a case report

CASE REPORT. Distal radius nonunion after volar locking plate fixation of a distal radius fracture: a case report Nagoya J. Med. Sci. 79. 551 ~ 557, 2017 doi:10.18999/nagjms.79.4.551 CASE REPORT Distal radius nonunion after volar locking plate fixation of a distal radius fracture: a case report Takaaki Shinohara 1

More information

The gluteal perforator-based flap in repair of pressure sores

The gluteal perforator-based flap in repair of pressure sores The British Association of Plastic Surgeons (2004) 57, 342 347 CASE REPORTS The gluteal perforator-based flap in repair of pressure sores Çilingir Meltem*, Çelik Esra, Fındık Hasan, Duman Ali Department

More information

BOAST 4 Algorithm. 6th September 2013

BOAST 4 Algorithm. 6th September 2013 BOAST 4 Algorithm 6th September 2013 Background The British Orthopaedic Association and the British Association of Plastic, Reconstructive and Aesthetic Surgeons reviewed their 1997 guidance and published

More information

Factors affecting fracture healing after intramedullary nailing of the tibial diaphysis for closed and grade I open fractures

Factors affecting fracture healing after intramedullary nailing of the tibial diaphysis for closed and grade I open fractures Trauma Factors affecting fracture healing after intramedullary nailing of the tibial diaphysis for closed and grade I open fractures G. I. Drosos, M. Bishay, I. A. Karnezis, A. K. Alegakis From Royal United

More information

Elsevier Editorial System(tm) for Journal of Hand Surgery (British & European Volume)

Elsevier Editorial System(tm) for Journal of Hand Surgery (British & European Volume) Elsevier Editorial System(tm) for Journal of Hand Surgery (British & European Volume) Manuscript Draft Manuscript Number: Title: Double-Barrel Free Fibula Flap for Treatment of Infected Nonunion of Both

More information

Double-barrel fibular graft for metaphyseal areas reconstruction around the knee

Double-barrel fibular graft for metaphyseal areas reconstruction around the knee Orthopaedics & Traumatology: Surgery & Research (2010) 96, 868 875 ORIGINAL ARTICLE Double-barrel fibular graft for metaphyseal areas reconstruction around the knee B. Coulet, J.-F. Pflieger, S. Arnaud,

More information

Lateral tibial condyle reconstruction by pedicled vascularized fibular head graft: Long-term result

Lateral tibial condyle reconstruction by pedicled vascularized fibular head graft: Long-term result Title Lateral tibial condyle reconstruction by pedicled vascularized fibular head graft: Long-term result Author(s) Ahmed, SK; Fung, BKK; Ip, WY; Chow, SP Citation Strategies In Trauma And Limb Reconstruction,

More information

The Open Orthopaedics Journal

The Open Orthopaedics Journal Send Orders for Reprints to reprints@benthamscience.ae 704 The Open Orthopaedics Journal, 2017, 11, (Suppl-4, M11) 704-713 The Open Orthopaedics Journal Content list available at: www.benthamopen.com/toorthj/

More information

Techique. Results. Discussion. Materials & Methods. Vol. 2 - Year 1 - December 2005

Techique. Results. Discussion. Materials & Methods. Vol. 2 - Year 1 - December 2005 to each other. The most distal interlocking hole is 3 mm proximal to distal end of nail, is in anteroposterior direction & proximal distal interlocking hole is in medial to lateral direction i.e. at right

More information

Malaysian Orthopaedic Journal 2018 Vol 12 No 3

Malaysian Orthopaedic Journal 2018 Vol 12 No 3 doi: http://dx.doi.org/10.5704/moj.1811.004 Functional Outcome after Treatment of Aggressive Tumours in the Distal Radius: Comparison between Reconstruction using Proximal Fibular Graft and Wrist Fusion

More information

Results of Surgical Treatment of Coxa Vara in Children: Valgus Osteotomy with Angle Blade Plate Fixation

Results of Surgical Treatment of Coxa Vara in Children: Valgus Osteotomy with Angle Blade Plate Fixation Results of Surgical Treatment of Coxa Vara in Children: Valgus Osteotomy with Angle Blade Plate Fixation Chatupon Chotigavanichaya MD*, Duangjai Leeprakobboon MD*, Perajit Eamsobhana MD*, Kamolporn Kaewpornsawan

More information

Treatment of ipsilateral femoral neck and shaft fractures. Mohamed E. Habib, Yasser S. Hannout, and Ahmed F. Shams

Treatment of ipsilateral femoral neck and shaft fractures. Mohamed E. Habib, Yasser S. Hannout, and Ahmed F. Shams Treatment of ipsilateral femoral neck and shaft fractures Mohamed E. Habib, Yasser S. Hannout, and Ahmed F. Shams Department of Orthopedic Surgery, Faculty of Medicine, University of El Minoufiya, Egypt

More information

Fractures of the tibia shaft treated with locked intramedullary nail Retrospective clinical and radiographic assesment

Fractures of the tibia shaft treated with locked intramedullary nail Retrospective clinical and radiographic assesment ARS Medica Tomitana - 2013; 4(75): 197-201 DOI: 10.2478/arsm-2013-0035 Șerban Al., Botnaru V., Turcu R., Obadă B., Anderlik St. Fractures of the tibia shaft treated with locked intramedullary nail Retrospective

More information

Open reduction and internal fixation of humeral non-unions : Radiological and functional results

Open reduction and internal fixation of humeral non-unions : Radiological and functional results Acta Orthop. Belg., 2011, 77, 299-303 ORIGINAL STUDY Open reduction and internal fixation of humeral non-unions : Radiological and functional results Anani ABALO, Ekoué D. DOSSEh, Komlan ADABRA, Atsi WALLA,

More information

Nonunion of the Femur Treated with Conventional Osteosynthesis Combined with Autogenous and Strut Allogeneic Bone Grafts

Nonunion of the Femur Treated with Conventional Osteosynthesis Combined with Autogenous and Strut Allogeneic Bone Grafts Original Article 268 Nonunion of the Femur Treated with Conventional Osteosynthesis Combined with Autogenous and Strut Allogeneic Bone Grafts Lin-Hsiu Weng, MD; Jun-Wen Wang, MD Background: In this study,

More information

Circumferential skin defect - Ilizarov technique in plastic surgery

Circumferential skin defect - Ilizarov technique in plastic surgery Brief Communication Circumferential skin defect - Ilizarov technique in plastic surgery Vrisha Madhuri, Shankar R. Kurpad, Manasseh Nithyananth, Thilak S Jepegnanam, V. T. K. Titus, Prema Dhanraj Department

More information

Laura M. Fayad, MD. Associate Professor of Radiology, Orthopaedic Surgery & Oncology The Johns Hopkins University

Laura M. Fayad, MD. Associate Professor of Radiology, Orthopaedic Surgery & Oncology The Johns Hopkins University Society of Pediatric Radiology, May 2013 Laura M. Fayad, MD Associate Professor of Radiology, Orthopaedic Surgery & Oncology The Johns Hopkins University Describes surgical techniques that resect and reconstruct

More information

Limb Salvage Surgery for Musculoskeletal Oncology

Limb Salvage Surgery for Musculoskeletal Oncology Editorial Limb Salvage Surgery for Musculoskeletal Oncology Wan Faisham Nu man Bin Wan Ismail Submitted: 2 May 2015 Accepted: 18 June 2015 Orthopaedic Oncology Unit, Orthopaedic Department, School of Medical

More information

Versatility of Reverse Sural Artery Flap for Heel Reconstruction

Versatility of Reverse Sural Artery Flap for Heel Reconstruction ORIGINAL ARTICLE Introduction: The heel has two parts, weight bearing and non-weight bearing part. Soft tissue heel reconstruction has been a challenge due to its complex nature of anatomy, weight bearing

More information

Femoral Shaft Fracture

Femoral Shaft Fracture Femoral Shaft Fracture The femoral shaft is well padded with muscles(an advantage in protecting the bone from all but the most powerful forces)but the disadvantage is that fractures are often severely

More information

Lower extremity trauma, with open highenergy RECONSTRUCTIVE

Lower extremity trauma, with open highenergy RECONSTRUCTIVE RECONSTRUCTIVE Lower Extremity Trauma: Trends in the Management of Soft-Tissue Reconstruction of Open Tibia-Fibula Fractures Brian M. Parrett, M.D. Evan Matros, M.D. Julian J. Pribaz, M.D. Dennis P. Orgill,

More information

Surgical treatment of aseptic nonunion in long bones: review of 193 cases

Surgical treatment of aseptic nonunion in long bones: review of 193 cases J Orthopaed Traumatol (2007) 8:11 15 DOI 10.1007/s10195-007-0155-z ORIGINAL A. Megaro S. Marchesi U.E. Pazzaglia Surgical treatment of aseptic nonunion in long bones: review of 193 cases Received: 5 September

More information

Segmental tibial fractures treated with unreamed interlocking nail A prospective study

Segmental tibial fractures treated with unreamed interlocking nail A prospective study 2017; 3(2): 714-719 ISSN: 2395-1958 IJOS 2017; 3(2): 714-719 2017 IJOS www.orthopaper.com Received: 13-02-2017 Accepted: 14-03-2017 Ashok Singhvi Hemant Jain Siddharth Jauhar Kishore Raichandani Segmental

More information

Treatment of malunited fractures of the ankle

Treatment of malunited fractures of the ankle Treatment of malunited fractures of the ankle A LONG-TERM FOLLOW-UP OF RECONSTRUCTIVE SURGERY I. I. Reidsma, P. A. Nolte, R. K. Marti, E. L. F. B. Raaymakers From Academic Medical Center, Amsterdam, Netherlands

More information

Large segmental defects of the tibia caused by highenergy. Ten Year Experience with Use of Ilizarov Bone Transport for Tibial Defects

Large segmental defects of the tibia caused by highenergy. Ten Year Experience with Use of Ilizarov Bone Transport for Tibial Defects Bulletin Hospital for Joint Diseases Volume 61, Numbers 3 & 4 2003-2004 101 Ten Year Experience with Use of Ilizarov Bone Transport for Tibial Defects Gene D. Bobroff, M.D., Stuart Gold, M.D., and Daniel

More information

Isolated congenital anterolateral bowing of the fibula : A case report with 24 years follow-up

Isolated congenital anterolateral bowing of the fibula : A case report with 24 years follow-up Acta Orthop. Belg., 2009, 75, 842-846 CASE REPORT Isolated congenital anterolateral bowing of the fibula : A case report with 24 years follow-up Karolien LELIEFELD, Hans VAN DER SLUIJS, Ibo VAN DER HAVEN

More information

Galal Zaki Said 1, *, Osama Ahmed Farouk 1, Hatem Galal Said 1

Galal Zaki Said 1, *, Osama Ahmed Farouk 1, Hatem Galal Said 1 KOWSAR Two-Stage Surgical Treatment for Non-Union of a Shortened Osteoporotic Femur Galal Zaki Said 1, *, Osama Ahmed Farouk 1, Hatem Galal Said 1 1 Department of Orthopedic Surgery, Faculty of Medicine,

More information

Outcome of Treatment of Nonunion Tibial Shaft Fracture by Intramedullary Interlocking Nail augmentated with Autogenous Cancellous Bone Graft.

Outcome of Treatment of Nonunion Tibial Shaft Fracture by Intramedullary Interlocking Nail augmentated with Autogenous Cancellous Bone Graft. Original Article Nepal Med Coll J 2014; 16(1): 58-62 Outcome of Treatment of Nonunion Tibial Shaft Fracture by Intramedullary Interlocking Nail augmentated with Autogenous Cancellous Bone Graft. Shah SB,

More information

Acute emergency tibialization of the fibula: reconstruction of a massive tibial defect in a type IIIC open fracture

Acute emergency tibialization of the fibula: reconstruction of a massive tibial defect in a type IIIC open fracture Strat Traum Limb Recon (2013) 8:127 131 DOI 10.1007/s11751-013-0167-6 CASE REPORT Acute emergency tibialization of the fibula: reconstruction of a massive tibial defect in a type IIIC open fracture Fatih

More information

Gastrocnemius Myocutaneous Flap: A Versatile Option to Cover the Defect of Upper and Middle Third Leg

Gastrocnemius Myocutaneous Flap: A Versatile Option to Cover the Defect of Upper and Middle Third Leg Downloaded from wjps.ir at 22:25 +0330 on Sunday November 18th 28 314 Gastrocnemius flap for coverage of leg defects Original Article Gastrocnemius Myocutaneous Flap: A Versatile Option to Cover the Defect

More information

Temporary Intentional Leg Shortening and Deformation to Facilitate Wound Closure Using the Ilizarov/Taylor Spatial Frame

Temporary Intentional Leg Shortening and Deformation to Facilitate Wound Closure Using the Ilizarov/Taylor Spatial Frame TECHNICAL TRICK Temporary Intentional Leg Shortening and Deformation to Facilitate Wound Closure Using the Ilizarov/Taylor Spatial Frame Shane J. Nho, MD, David L. Helfet, MD, and S. Robert Rozbruch, MD

More information

Biological Reconstruction after Excision of Juxta-articular Osteosarcoma around the Knee: A New Classification System

Biological Reconstruction after Excision of Juxta-articular Osteosarcoma around the Knee: A New Classification System Biological Reconstruction after Excision of Juxta-articular Osteosarcoma around the Knee: A New Classification System HIROYUKI TSUCHIYA 1, MOHAMED E. ABDEL-WANIS 2 and KATSURO TOMITA 1 1 Department of

More information

BUILDING A. Achieving total reconstruction in a single operation. 70 OCTOBER 2016 // dentaltown.com

BUILDING A. Achieving total reconstruction in a single operation. 70 OCTOBER 2016 // dentaltown.com BUILDING A MANDI Achieving total reconstruction in a single operation by Dr. Fayette C. Williams Fayette C. Williams, DDS, MD, FACS, is clinical faculty at John Peter Smith Hospital in Fort Worth, Texas,

More information

Adult Posttraumatic Reconstruction Using a Magnetic Internal Lengthening Nail

Adult Posttraumatic Reconstruction Using a Magnetic Internal Lengthening Nail SUPPLEMENT ARTICLE Adult Posttraumatic Reconstruction Using a Magnetic Internal Lengthening Nail S. Robert Rozbruch, MD Summary: A new generation of internal lengthening nail is now available that has

More information

Breast Reconstruction with Superficial Inferior Epigastric Artery Flaps: A Prospective Comparison with TRAM and DIEP Flaps

Breast Reconstruction with Superficial Inferior Epigastric Artery Flaps: A Prospective Comparison with TRAM and DIEP Flaps Breast Reconstruction with Superficial Inferior Epigastric Artery Flaps: A Prospective Comparison with TRAM and DIEP Flaps Pierre M. Chevray, M.D., Ph.D. Houston, Texas Breast reconstruction using the

More information

Distal femoral fracture with subsequent ipsilateral proximal femoral fracture

Distal femoral fracture with subsequent ipsilateral proximal femoral fracture Distal femoral fracture with subsequent ipsilateral proximal femoral fracture by M Agarwal, MS FRCS, AA Syed, FRCSI, PV Giannoudis (!), BSc,MB,MD,EEC(Orth) Dept. of Orthopaedics and Trauma, St.James University

More information

Use of Unlocked Intramedullary Nailing in Winquist Type I and II Femoral Isthmus Fracture

Use of Unlocked Intramedullary Nailing in Winquist Type I and II Femoral Isthmus Fracture Use of Unlocked Intramedullary Nailing in Winquist Type I and II Femoral Isthmus Fracture HT Ling, MBBS (UM), WM Ng, MS Ortho (UM), MK Kwan, MS Ortho (UM), LK Fathi Aizuddeen, MBBS (UM), PCM Tay, MBBS

More information

Treatment Alternatives for Pediatric Femoral Fractures

Treatment Alternatives for Pediatric Femoral Fractures Treatment Alternatives for Pediatric Femoral Fractures Gregory A. Schmale, MD Seattle Children's Hospital, USA, gregory.schmale@seattlechildrens.org version 2 I have no conflicts of interest to report

More information

Correction of Traumatic Ankle Valgus and Procurvatum using the Taylor Spatial Frame: A Case Report

Correction of Traumatic Ankle Valgus and Procurvatum using the Taylor Spatial Frame: A Case Report The Foot and Ankle Online Journal Official publication of the International Foot & Ankle Foundation Correction of Traumatic Ankle Valgus and Procurvatum using the Taylor Spatial Frame: A Case Report by

More information

Interesting Case Series. Scalp Reconstruction With Free Latissimus Dorsi Muscle

Interesting Case Series. Scalp Reconstruction With Free Latissimus Dorsi Muscle Interesting Case Series Scalp Reconstruction With Free Latissimus Dorsi Muscle Danielle H. Rochlin, BA, Justin M. Broyles, MD, and Justin M. Sacks, MD Department of Plastic and Reconstructive Surgery,

More information

CASE REPORT. Antegrade tibia lengthening with the PRECICE Limb Lengthening technology

CASE REPORT. Antegrade tibia lengthening with the PRECICE Limb Lengthening technology CASE REPORT Antegrade tibia lengthening with the PRECICE Limb Lengthening technology Austin T. Fragomen, M.D. Hospital for Special Surgery New York, NY 1 1 PR O D U CTS CONDITION Nonunion of an attempted

More information

Central bone grafting for nonunion of fractures of the tibia

Central bone grafting for nonunion of fractures of the tibia Central bone grafting for nonunion of fractures of the tibia A RETROSPECTIVE SERIES M. Ryzewicz, S. J. Morgan, E. Linford, J. I. Thwing, G. V. P. de Resende, W. R. Smith From Denver Health Medical Center,

More information

The chimeric lateral femoral condyle flap for reconstruction of a long bone defect in the hand

The chimeric lateral femoral condyle flap for reconstruction of a long bone defect in the hand Case Report Page 1 of 6 The chimeric lateral femoral condyle flap for reconstruction of a long bone defect in the hand Lucian P. Jiga, Zaher Jandali Department of Plastic, Aesthetic, Reconstructive and

More information

Of approximately 2 million long bone fractures

Of approximately 2 million long bone fractures Proceedings S.Z.P.G.M.I vol: 13(1-2) 1999, pp. 71-75. Treatment of Tibial Non-Union with the Ilizarov Method Pervaiz Iqbal, Muhammad Maq, Hamid Qayum Department of Orthopaedics, Shaikh Zayed Hospital,.

More information

A 42-year-old patient presenting with femoral

A 42-year-old patient presenting with femoral Kanda et al. Journal of Medical Case Reports 2015, 9:17 JOURNAL OF MEDICAL CASE REPORTS CASE REPORT Open Access A 42-year-old patient presenting with femoral head migration after hemiarthroplasty performed

More information

Stress Fracture Of The Supracondylar Region Of The Femur Induced By The Weight Of The Tibial Ring Fixator

Stress Fracture Of The Supracondylar Region Of The Femur Induced By The Weight Of The Tibial Ring Fixator ISPUB.COM The Internet Journal of Orthopedic Surgery Volume 4 Number 1 Stress Fracture Of The Supracondylar Region Of The Femur Induced By The Weight Of The Tibial Ring S Dhar, M Mir Citation S Dhar, M

More information

Case Report. Antegrade Femur Lengthening with the PRECICE Limb Lengthening Technology

Case Report. Antegrade Femur Lengthening with the PRECICE Limb Lengthening Technology Case Report Antegrade Femur Lengthening with the PRECICE Limb Lengthening Technology S. Robert Rozbruch, MD Hospital for Special Surgery New York, NY, USA ABSTRACT This is a case illustrating a 4.5 cm

More information

Charcot Foot: Potential Pearls from Parkland

Charcot Foot: Potential Pearls from Parkland Charcot Foot: Potential Pearls from Parkland Javier La Fontaine, D.P.M., M.S. Professor Department of Plastic Surgery UT Southwestern Medical Center Dallas, Texas Objectives To share the experience from

More information

Clinical Study Distal Femur Allograft Prosthetic Composite Reconstruction for Short Proximal Femur Segments following Tumor Resection

Clinical Study Distal Femur Allograft Prosthetic Composite Reconstruction for Short Proximal Femur Segments following Tumor Resection Advances in Orthopedics Volume 2013, Article ID 397456, 5 pages http://dx.doi.org/10.1155/2013/397456 Clinical Study Distal Femur Allograft Prosthetic Composite Reconstruction for Short Proximal Femur

More information

Vascularized Fibula Grafts

Vascularized Fibula Grafts Vascularized Fibula Grafts 311 16 Vascularized Fibula Grafts Clinical Applications Richard S. Gilbert, MD and Scott W. Wolfe, MD INTRODUCTION The reconstruction of large skeletal defects has posed a challenging

More information

Plate vs Nail for Distal Tibia Fxs

Plate vs Nail for Distal Tibia Fxs Plate vs Nail for Distal Tibia Fxs Frank A. Liporace, MD Associate Professor Dept. of Orthopaedics NYU / HJD Chief Dept. Of Orthopaedics JCMC / RWJBH ??? Controversy??? Nails Minimal invasive Low blood

More information

Unlocked Nailing vs. Interlocking Nailing for Winquist Type I and II Femoral Isthmus Fractures. Is there a Difference?

Unlocked Nailing vs. Interlocking Nailing for Winquist Type I and II Femoral Isthmus Fractures. Is there a Difference? Unlocked Nailing vs. Interlocking Nailing for Winquist Type I and II Femoral Isthmus Fractures. Is there a Difference? CK Yu, MBBS (UM), HY Wong*, MD (UKM), AS Vivek, FRCS (Edin), BC Se To*, FRCS (Edin)

More information