Pawan Agarwal1, Rajiv Savant2, Dhananjaya Sharma3. 1. Plastic Surgery Unit, NSCB Government Medical College, Jabalpur, MP, 482003, India. 2. Jamdar Hospital, Gole Bazar, Jabalpur, MP, 482002, India. 3. Department of Surgery NSCB Government Medical College, Jabalpur, MP, 482003, India.
Abstract
BACKGROUND: Management of gap nonunion of tibia is difficult for the surgeons, and time consuming for patients with unpredictable results. There are various methods to treat gap nonunion, but each one has its own limitations. We report the outcomes of ipsilateral fibular transposition (Huntington's procedure) for reconstruction of major tibial defects. METHODS: It is a retrospective study including 4 patients who underwent ipsilateral vascularized transposition of fibula for gap nonunion of tibia. Fibula was transferred to tibia as vascularized pedicle graft in one-staged procedure. RESULTS: Single stage fibular transposition was performed in four patients. The transferred fibula united in all patients. Mean follow-up after fibular transposition was 1.2 years. Partial weight bearing started after an average of 5.25 months till hypertrophy of fibula is seen on radiographs than full weight bearing started. The mean time to healing was 7.5 months (range: 5-10 months). Tibialization of fibula occurred in all patients as evident on radiographs. CONCLUSIONS: Huntington procedure is a simple and technically easy for large tibial defects. It does not require microsurgical skill and implants. The union of transferred fibula is faster than conventional graft as it is a vascularized graft. It is a rational choice for the treatment of large tibial defects in selected cases.
BACKGROUND: Management of gap nonunion of tibia is difficult for the surgeons, and time consuming for patients with unpredictable results. There are various methods to treat gap nonunion, but each one has its own limitations. We report the outcomes of ipsilateral fibular transposition (Huntington's procedure) for reconstruction of major tibial defects. METHODS: It is a retrospective study including 4 patients who underwent ipsilateral vascularized transposition of fibula for gap nonunion of tibia. Fibula was transferred to tibia as vascularized pedicle graft in one-staged procedure. RESULTS: Single stage fibular transposition was performed in four patients. The transferred fibula united in all patients. Mean follow-up after fibular transposition was 1.2 years. Partial weight bearing started after an average of 5.25 months till hypertrophy of fibula is seen on radiographs than full weight bearing started. The mean time to healing was 7.5 months (range: 5-10 months). Tibialization of fibula occurred in all patients as evident on radiographs. CONCLUSIONS: Huntington procedure is a simple and technically easy for large tibial defects. It does not require microsurgical skill and implants. The union of transferred fibula is faster than conventional graft as it is a vascularized graft. It is a rational choice for the treatment of large tibial defects in selected cases.
Authors: Ellen J MacKenzie; Michael J Bosse; James F Kellam; Andrew R Burgess; Lawrence X Webb; Marc F Swiontkowski; Roy Sanders; Alan L Jones; Mark P McAndrew; Brendan Patterson; Melissa L McCarthy; Charles A Rohde Journal: J Trauma Date: 2002-04