Long-term follow-up on the use of vascularized fibular graft for the treatment of congenital pseudarthrosis of the tibia
mahmoud el-rosasy, Department of Orthopaedic Surgery - Tanta University Hospitals - Tanta - Egypt
2 November 2008
Dear Sir:
I read with interest this article, however, I have some comments for the authors and readers:
(1) The authors described a well known technique of fibular transposition to bridge the tibial defect [1]. This technique would burn the bridges in case it failed where the limb would loose the fibular support and renders following reconstructive procedures difficult and may even urge the surgeon to recommend amputation rather than reconstruction. The current literature does not support the primary use of this technique except in certain cases of extensive bone loss and soft tissue fibrosis.
(2) From the analysis of the results in this study; the leg length discrepancy (LLD) was more than 5 cm. in four cases, the valgus ankle deformity more than 20 degrees in four cases and ankle pain in three cases. This unacceptably high complications rate in only eight cases does not justify the conclusion to recommend using this procedure primarily in cases of CPT. On the other hand the authors did not clarify how a patient with 15.7 cm. could function with such a limb.
(3) The main aim of limb reconstruction is to provide the patient with a limb to carry him rather than carrying it. In which cases the recommendation of amputation and prosthetic fitting would be much better from a functional standpoint.
(4) the authors described the fibular transposition without any trial to stabilize the ankle joint which in my opinion is the main reason for valgus deformity and instability of the ankle and late arthritis and pain.
(5) I strongly caution the readers against using the described technique in preference to the well documented techniques with predictably good bony and functional outcomes e.g. Ilizarov technique combined with intramedullary rod and bone grafting [2, 3].
REFERENCES:
(1) Huntington TW. VI. Case of Bone Transference: Use of a Segment of Fibula to Supply a Defect in the Tibia. Ann Surg. 1905;41(2):249-51.
(2) El-Rosasy MA, Paley D, Herzenburg JE (2007) Congenital Pseudarthrosis of the Tibia. In: Rozbruch RS, Ilizarov S (eds) Limb lengthening and reconstruction surgery. Informa Healthcare USA, New York, pp 485–493
(3) Paley D, Catagni M, Argnani F, Prevot J, Bell D, Armstrong P. Treatment of congenital pseudoarthrosis of the tibia using the Ilizarov technique. Clin Orthop. 1992;280:81–93
Journal of Orthopaedic Surgery and Research
Long-term follow-up on the use of vascularized fibular graft for the treatment of congenital pseudarthrosis of the tibia
2 November 2008
Dear Sir:
I read with interest this article, however, I have some comments for the authors and readers:
(1) The authors described a well known technique of fibular transposition to bridge the tibial defect [1]. This technique would burn the bridges in case it failed where the limb would loose the fibular support and renders following reconstructive procedures difficult and may even urge the surgeon to recommend amputation rather than reconstruction. The current literature does not support the primary use of this technique except in certain cases of extensive bone loss and soft tissue fibrosis.
(2) From the analysis of the results in this study; the leg length discrepancy (LLD) was more than 5 cm. in four cases, the valgus ankle deformity more than 20 degrees in four cases and ankle pain in three cases. This unacceptably high complications rate in only eight cases does not justify the conclusion to recommend using this procedure primarily in cases of CPT. On the other hand the authors did not clarify how a patient with 15.7 cm. could function with such a limb.
(3) The main aim of limb reconstruction is to provide the patient with a limb to carry him rather than carrying it. In which cases the recommendation of amputation and prosthetic fitting would be much better from a functional standpoint.
(4) the authors described the fibular transposition without any trial to stabilize the ankle joint which in my opinion is the main reason for valgus deformity and instability of the ankle and late arthritis and pain.
(5) I strongly caution the readers against using the described technique in preference to the well documented techniques with predictably good bony and functional outcomes e.g. Ilizarov technique combined with intramedullary rod and bone grafting [2, 3].
REFERENCES:
(1) Huntington TW. VI. Case of Bone Transference: Use of a Segment of Fibula to Supply a Defect in the Tibia. Ann Surg. 1905;41(2):249-51.
(2) El-Rosasy MA, Paley D, Herzenburg JE (2007) Congenital Pseudarthrosis of the Tibia. In: Rozbruch RS, Ilizarov S (eds) Limb lengthening and reconstruction surgery. Informa Healthcare USA, New York, pp 485–493
(3) Paley D, Catagni M, Argnani F, Prevot J, Bell D, Armstrong P. Treatment of congenital pseudoarthrosis of the tibia using the Ilizarov technique. Clin Orthop. 1992;280:81–93
Competing interests
No competing interests