BACKGROUND: The objectives of the present study were to investigate the reliability and outcomes of computer-assisted techniques in mandibular reconstruction with a fibula flap and verify whether the surgical navigation system was feasible in mandible reconstructive surgery. METHODS: Eight cases were enrolled in the computer assisted surgery (CAS) group and 14 cases in the traditional group. The shaping and fixation of the fibula grafts were guided by computer assisted techniques, which could be monitored with the BrainLAB surgical navigation system. The variation of mandible configuration was evaluated by CT measurement in the Mimics software, including the variation of length, width, height and gonial angle of the mandible. The 3D facial soft tissue alteration was also analyzed in 3D chromatogram by Geomagic software. RESULTS: All 22 fibula flaps survived. The mandibular configurations and facial contours had a better clinic result in the CAS group. The length, width, height and gonial angle of the reconstructive mandible were more similar to the original one. The Wilcoxon rank sum test analysis suggested significant differences in the measurements. The chromatographic analysis also visually showed superiority over the traditional group. CONCLUSIONS: The computer assisted surgical navigation method used in mandibular reconstruction is feasible and precise for clinical application. The contour of the reconstructed mandible and facial symmetry are improved with computer techniques.
Fibula ; Mandible ; Mandibular Reconstruction* ; Methods ; Surgery, Computer-Assisted ; Transplants

Both severed legs were replanted in a 41-year-old man. Bilateral tibia and fibula were shortened by 4 cm equally. Tibial fixation was performed with reconstruction plate. Four weeks after the replantation, active and passive exercises were initiated in both of the knee joints. Four months after surgery, the patient was capable of walking independently for 20-30 m without the aid of crutches. After 28 months' follow-up, plantar sensitivity was defined as S3. This patient was satisfactory with the cosmetic and functional results.
Amputation, Traumatic ; surgery ; Fibula ; Humans ; Leg ; Male ; Replantation ; Tibia

Avascular osteonecrosis of the femoral head is a common disease in orthopedic clinics. If the diagnosis can be made before collapse of the femoral head, the hip joint may probably be preserved by means of core decompression with or without bone grafting, osteotomies, as well as nonvascularized or vascularized bone grafting. Local pedicled bone grafts and free vascularized bone grafts can transfer the vascularized bone grafts into the necrotic area of the femoral head, which not only can replace necrotic bone with healthy bone, but also establish a new source of blood supply to the femoral head. The success rate in patients with different stages of osteonecrosis of femoral head was 80% at 5 years follow up. Free vascularized bone grafting for the treatment of avascular osteonecrosis of the femoral head can obtain a higher success rate.
Bone Transplantation ; methods ; Femur Head Necrosis ; surgery ; Fibula ; transplantation ; Humans

Child ; Fibula ; transplantation ; Humans ; Male ; Periosteum ; transplantation ; Wrist Joint ; surgery

fibula flap has become the gold standard for most mandibular reconstructions because of its favorable osseous characteristics. However, disadvantages, such as the time-consuming reconstructive step, difficulty in performing the osteotomies to precisely recreate the shape of the missing segment of mandible and poor bone-to-bone contact play a role in making the surgeons look for alternative flaps. With the advent of computerized design software, which accurately plans complex 3-dimensional reconstructions, has become a process that is more efficient and precise. However, the ability to transfer the computerized plan into the surgical field with stereolithographic models and guides has been a significant development in advancing reconstruction in the maxillofacial regions. The ability to "pre-plan" the case, mirror and superimpose natural structures into diseased and deformed areas, as well as the ability to reproduce these plans with good surgical precision has decreased overall operative time, and has helped facilitate functional and esthetic reconstruction. We describe a complex case treated with this technique, showing the power and elegance of computer assisted maxillofacial reconstruction from the University of Michigan, Oral and Maxillofacial Surgery.]]>
Fibula ; Mandible ; Mandibular Reconstruction ; Michigan ; Operative Time ; Osteotomy ; Surgery, Oral

OBJECTIVE: To establish the finite element model of varus-type ankle arthritis and to implement the finite element mechanical analysis of different correction models for tibial anterior surface angle (TAS) in supramalleolar osteotomy. METHODS: A female patient with left varus-type ankle arthritis (Takakura stage Ⅱ, TAS 78°) was taken as the study object. Based on the CT data, the three-dimensional model of varus-type ankle arthritis (TAS 78°) and different TAS correction models [normal (TAS 89°), 5° valgus (TAS 94°), and 10° valgus (TAS 99°)] were created by software Mimics 21.0, Geomagic Wrap 2021, Solidworks 2017, and Workbench 17.0. The 290 N vertical downward force was applied to the upper surface of the tibia and 60 N vertical downward force to the upper surface of the fibula. Von Mises stress distribution and stress peak were calculated. RESULTS: The finite element model of normal TAS was basically consistent with biomechanics of the foot. According to biomechanical analysis, the maximum stress of the varus model appeared in the medial tibiotalar joint surface and the medial part of the top tibiotalar joint surface. The stress distribution of talofibular joint surface and the lateral part of the top tibiotalar joint surface were uniform. In the normal model, the stress distributions of the talofibular joint surface and the tibiotalar joint surface were uniform, and no obvious stress concentration was observed. The maximum stress in the 5° valgus model appeared at the posterior part of the talofibular joint surface and the lateral part of the top tibiotalar joint surface. The stress distribution of medial tibiotalar joint surface was uniform. The maximum stress of the 10° valgus model appeared at the posterior part of the talofibular joint surface and the lateral part of the top tibiotalar joint surface. The stress on the medial tibiotalar joint surface increased. CONCLUSION With the increase of valgus, the stress of ankle joint gradually shift outwards, and the stress concentration tends to appear. There was no obvious obstruction of fibula with 10° TAS correction. However, when TAS correction exceeds 10° and continues to increase, the obstruction effect of fibula becomes increasingly significant.
Humans ; Female ; Tibia/surgery* ; Finite Element Analysis ; Ankle ; Arthritis ; Fibula/surgery* ; Ankle Joint/surgery*

This article reviews the history and development of as well as the results using a fibular graft by vascular anastomosis for the treatment of avascular osteonecrosis of the femoral head. Vascular anastomosed fibular grafting has been reported to be successful for patients with early stages and precollapse osteonecrosis of the femoral head. The method can be used to preserve the hip joint function. Vascular anastomosed fibular grafting can be the transfer of vascularized bone grafts into the necrotic portions of the femoral head. Such a procedure, in addition to replacing necrotic bone with healthy bone, also establishes a new source of circulating blood of the femoral head. Free avascularized bone grafting for the treatment of avascular osteonecrosis of the femoral head may lead to higher rates of successful treatment and superior to those of core decompression and nonoperative treatment.
Anastomosis, Surgical ; Bone Transplantation ; Femur Head ; surgery ; Femur Head Necrosis ; surgery ; Fibula ; transplantation ; Humans ; Treatment Outcome

Fibula ; injuries ; surgery ; Fracture Healing ; Orthopedic Fixation Devices ; Tibial Fractures ; surgery ; therapy ; Time Factors

Proximal tibiofibular instability is a rare condition for which treatment is poorly codified. A 21-year-old patient, a leisure sportswoman, presented a post-traumatic anterolateral instability of the proximal tibiofibular articulation without cartilage lesion. We propose an original surgical technique based on a review of the literature that combines an anatomical ligamentoplasty of the proximal tibiofibular joint and a proximal fibular diaphyseal osteotomy to reduce the distal tibiofibular mechanical stresses. This original technique allows a favorable evolution with recovery of professional and sports activities at 6 months.
Adult ; Fibula ; Humans ; Knee Joint/surgery* ; Osteotomy/methods* ; Tibia/surgery* ; Young Adult

OBJECTIVE: To compare the role and importance of fibular fixation in tibiofibular fractures by Meta-analysis. METHODS: The literature related to the comparison of the efficacy of fixation of the fibula with or without fixation on the treatment of tibiofibular fractures was searched through the databases of China Knowledge Network, Wipu, Wanfang, The Cochrane Library, Web of science and Pubmed, and statistical analysis was performed using RevMan 5.3 software. The rates of malrotation, rotational deformity, internal/external deformity, anterior/posterior deformity, non-union, infection, secondary surgery and operative time were compared between the fibula fixation and non-fixation groups. RESULTS: A total of 11 publications were included, six randomised controlled trials and five case-control trials, eight of which were of high quality. A total of 813 cases were included, of which 383 were treated with fibula fixation and 430 with unfixed fibulae.Meta-analysis results showed that fixation of the fibulae in the treatment of tibiofibular fractures reduced the rates of postoperative rotational deformity[RR=0.22, 95%CI(0.10, 0.45), P<0.000 1] and internal/external deformity[RR=0.34, 95%CI(0.14, 0.84), P=0.02] and promoted fracture healing [RR=0.76, 95%CI(0.58, 0.99), P=0.04]. In contrast, the rates of poor reduction [RR=0.48, 95% CI(0.10, 2.33), P=0.36], anterior/posterior deformity[RR=1.50, 95%CI(0.76, 2.96), P=0.24], infection[RR=1.43, 95%CI(0.76, 2.72), P=0.27], secondary surgery[RR=1.32, 95%CI(0.82, 2.11), P=0.25], and operative time[MD=10.21, 95%CI(-17.79, 38.21), P=0.47] were not statistically significant (P>0.05) for comparison. CONCLUSION Simultaneous fixation of the tibia and fibula is clinically more effective in the treatment of tibiofibular fractures.
Humans ; Fibula/surgery* ; Fractures, Bone/complications* ; Tibia/surgery* ; Fracture Healing ; Fracture Fixation, Internal ; Treatment Outcome