International Orthopaedics

, Volume 43, Issue 8, pp 1927–1931 | Cite as

Fibular donor site following non vascularized harvest: clinico-radiological outcome at minimal five year follow-up

  • Anil Agarwal
Original Paper



The long-term donor site outcome of non vascularized fibular harvest in paediatric age group is not well studied. We evaluated clinical and radiological characteristics of fibular harvest site in children at a minimum five year follow-up.


The patients with donor legs underwent both physical and radiographic examination. Clinical parameters evaluated were pain, neuromuscular weakness, and standing tibiocalcaneal hindfoot valgus in the donor limb. Radiologically, longitudinal non continuity in regeneration, medullary canal reformation, Malhotra grading, and lateral distal tibial angle (LDTA) were documented.


Sixteen patients (18 legs) were available for follow-up. The average follow-up was 6.23 ± 1.1 years. None of the patients reported pain or neuromuscular weakness related to the donor leg. Five patients reported cosmesis issues related to exaggerated ankle valgus. Medullary canal restoration was seen in 3/14 regenerated fibulae. Harvested legs had overall higher fibular station than contralateral unintervened ankles. Non continuity in regeneration were seen in 4/18 legs. There was clinical hindfoot valgus, abnormal LDTA, and fibular station in these patients. Clinical valgus matched better with a combination of fibular station and LDTA (83.3%) rather than fibular station or LDTA (75%) alone.


Fibular regeneration was complete in more than 75% legs at follow-up of > five years but remodeling and reformation of medullary canal was delayed. Long-term fibular non regeneration was persistently responsible for development of ankle valgus deformity. Middle lower third fibular junction is critical area for non restoration of medullary canal and non continuity.


Non vascularized graft Fibula Children Ankle valgus Regeneration 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Research involving human participants and/or animals

Retrospective study.

Informed consent



  1. 1.
    González-Herranz P, del Río A, Burgos J, López-Mondejar JA, Rapariz JM (2003) Valgus deformity after fibular resection in children. J Pediatr Orthop 23:55–59PubMedGoogle Scholar
  2. 2.
    Kang SH, Rhee SK, Song SW, Chung JW, Kim YC, Suhl KH (2010) Ankle deformity secondary to acquired fibular segmental defect in children. Clin Orthop Surg 2:179–185CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Agarwal A, Kumar D, Agrawal N, Gupta N (2017) Ankle valgus following non-vascularized fibular grafts in children - an outcome evaluation minimum two years after fibular harvest. Int Orthop 4:949–955CrossRefGoogle Scholar
  4. 4.
    Sulaiman AR, Wan Z, Awang S, Che Ahmad A, Halim AS, Ahmad Mohd Zain R (2015) Long-term effect on foot and ankle donor site following vascularized fibular graft resection in children. J Pediatr Orthop B 24:450–455CrossRefPubMedGoogle Scholar
  5. 5.
    Nathan SS, Athanasian E, Boland PJ, Healey JH (2009) Valgus ankle deformity after vascularized fibular reconstruction for oncologic disease. Ann Surg Oncol 16:1938–1945CrossRefPubMedGoogle Scholar
  6. 6.
    Pacelli LL, Gillard J, McLoughlin SW, Buehler MJ (2003) A biomechanical analysis of donor-site ankle instability following free fibular graft harvest. J Bone Joint Surg Am 85:597–603CrossRefPubMedGoogle Scholar
  7. 7.
    Bettin D, Böhm H, Clatworthy M, Zurakowski D, Link TM (2003) Regeneration of the donor side after autogenous fibula transplantation in 53 patients: evaluation by dual x-ray absorptiometry. Acta Orthop Scand 74:332–336CrossRefPubMedGoogle Scholar
  8. 8.
    Xin Z, Kim K, Jung S (2009) Regeneration of the fibula using a periosteum-preserving technique in children. Orthopedics 32:820PubMedGoogle Scholar
  9. 9.
    Soejima O, Ogata K, Ishinishi T, Fukahori Y, Miyauchi R (1994) Anatomic considerations of the peroneal nerve for division of the fibula during high tibial osteotomy. Orthop Rev 23:244–247PubMedGoogle Scholar
  10. 10.
    Haight HJ, Dahm DL, Smith J, Krause DA (2005) Measuring standing hindfoot alignment: reliability of goniometric and visual measurements. Arch Phys Med Rehabil 86:571–575CrossRefPubMedGoogle Scholar
  11. 11.
    Slullitel G, Álvarez V, Lopez V, Calvi JP, Calvo AB (2017) How accurate is clinical evaluation in hindfoot coronal alignment? Foot Ankle Orthop 2:1–7. CrossRefGoogle Scholar
  12. 12.
    Malhotra D, Puri R, Owen R (1984) Valgus deformity of the ankle in children with spina bifida aperta. J Bone Joint Surg Br 66:381–385CrossRefPubMedGoogle Scholar
  13. 13.
    Stevens PM (2015) Pediatric ankle valgus: background, anatomy, pathophysiology. Accessed 15 March 2018
  14. 14.
    Burchardt H (1983) The biology of bone graft repair. Clin Orthop Relat Res 174:28–42Google Scholar
  15. 15.
    Steinlechner CW, Mkandawire NC (2005) Non-vascularised fibular transfer in the management of defects of long bones after sequestrectomy in children. J Bone Joint Surg Br 87:1259–1263CrossRefPubMedGoogle Scholar
  16. 16.
    Guo F (1981) Observations of the blood supply to the fibula. Arch Orthop Trauma Surg 98:147–151CrossRefPubMedGoogle Scholar

Copyright information

© SICOT aisbl 2018

Authors and Affiliations

  • Anil Agarwal
    • 1
  1. 1.Department of Paediatric OrthopaedicsChacha Nehru Bal ChikitsalayaDelhiIndia

Personalised recommendations