Regeneration of Fibula Following Distal Fibulectomy for Ankle Arthrodesis Following the Use of Calcium Sulphate Granules: A Case Series and Review of the Literature

Regeneration of the fibula following partial fibulectomy is a common and well-reported phenomenon in children. However, there is limited literature on the regeneration of fibula in skeletally mature individuals. We report a case series of regeneration of the distal fibula following partial distal fibulectomy. In both these cases, calcium sulphate (Stimulan-Biocomposites, Keele, UK) antibiotic-loaded beads were used for local delivery of a high concentration of antibiotics. However, calcium sulphate worked as an osteoconductive agent and led to regeneration of the fibula. Regeneration of the fibula has its benefits and downside. Regeneration can be beneficial in patients in whom future arthroplasty is considered as total ankle replacement would not be possible in the absence of distal fibula. On the contrary, a regenerated fibula can be a source of ankle pain related to the syndesmotic joint. There is also a report of infection recurring in the regenerated fibula. Hence, while using calcium sulphate beads either as a spacer or as a vehicle for local delivery of antibiotics, the operating surgeon needs to be aware of the risk of regeneration of the fibula if the periosteum is preserved.