Abstract
Seven children, aged four to nine years, underwent fibular transfer between 1990 and 2002. Five had chronic osteomyelitis and two had septic compound fractures. Bone defects measured 5 cm to 20 cm. Reconstruction was performed in two stages. Debridement, sequestrectomy, and Gentamycin bead insertion were performed first. Two children required skin grafting and one a gastrocnemius flap.
Fibular transfer was performed as a second stage at four to six weeks, when infection was cleared. Through an anterolateral approach the fibula was divided proximally below the physis and transferred from the lateral to the anterior compartment deep to the tibialis anterior muscle belly. The fibula was fixed with screws to the lateral tibial metaphysis in two children, and placed into the medullary canal and fixed with wires in four. Distal procedures were performed in five children.
Patients were immobilised in a cast for three to six months until bone healing occurred, after which the bone was supported with a calliper. Follow-up ranged from 11 months to 13 years. All transfers united to the proximal tibia by 12 weeks. Fibular hypertrophy occurred in all children. There was shortening of 3 cm to 10 cm. Equinus deformity occurred in two children and varus of the ankle in three. All are ambulant with boots and crutches.
Fibular transfer is a useful salvage procedure and an alternative to ablation in severe tibial infections with defects. It has a free blood supply and hypertrophies with weight-bearing.
The abstracts were prepared by Professor M. B. E. Sweet. Correspondence should be addressed to him at PO Box 47363, Parklands, Johannesburg 2121, South Africa.
