FIBULA OSTEOTOMY IN LENGTHENING AND CORRECTION: WHICH FACTORS INFLUENCE OUTCOME?

Statement of purpose To determine whether the amount of fibula resection in fibula osteotomy influences outcome in deformity correction surgery. Methods Retrospective case note and imaging review was performed on a cohort of 45 patients from November 2005 to July 2009 treated with lengthening and/or correction for leg deformity in either an adult or paediatric limb reconstruction centre. Method, extent and level of original fibular resection was recorded, as well as type of fixator, distraction regime and total gap at osteotomy site after distraction. Outcome was measured as premature, expected or non-union and subsequent need for reintervention. Results Fibula osteotomies were made in 45 patients with a mean age of 23 (median 16, range 6–65). 14 subsequently underwent lengthening only, 15 correction of deformity only and 16 a combination of the two. 32 cases used the Ilizarov frame, four the Taylor-Spatial frame and 9 the Sheffield ring fixator. The mean extent of fibular resection was 3.6 mm (range 0.5–17 mm), with saw osteotomy used more frequently than drill or osteotome. Mean latency from surgery to distractions starting was 6 days. Premature union preventing further distraction/correction occurred in four cases, three of which required repeat osteotomy and one which resolved after increasing the rate of distractions. 37 osteotomies went on to unite, with four non-unions. These non-unions were asymptomatic and did not require further intervention. Conclusion The extent of fibular resection does not appear to directly influence outcome in terms of symptomatic fibular non-union requiring intervention. Care needs to be taken in the paediatric population to guard against premature union requiring repeat osteotomy.