Abstract
Background Malignant bone tumors of the distal tibia or fibula in children are rare. Quality
of functional outcome following limb salvage surgery is still controversial. This
is a retrospective review of the functional outcome of ankle arthrodesis using vascularized
fibular flap.
Methods A total of seven patients were reviewed. The diagnosis was osteosarcoma in five and
Ewing's sarcoma in two patients. The primary tumor site was the distal tibia in six
patients and the distal fibula in one patient. The average age at presentation was
10.6 years (range, 6.7–14 years). The average follow-up period was 24.5 months (range,
13–69 years). A pedicled fibular graft was harvested from the ipsilateral leg in two
patients and a free vascularized osteocutaneous fibular flap from the contralateral
leg in five patients. External fixation was used in five and internal fixation in
two patients. Patients were allowed full weight bearing following radiographic evidence
of complete bone union.
Results The mean time to complete bone union and full weight bearing was 7.1 months (range,
4–13 months). One patient developed nonunion at graft-host junction and one patient
had stress fracture of the fibular graft. The mean limb length inequality was 0.57
cm (range, 0–3 cm). The average Musculoskeletal Tumor Society (MSTS) score was 84.5%
(range, 73–100%).
Conclusion Skeletally immature patients treated by ankle arthrodesis using vascularized fibular
flap can return to full weight bearing within the first year following surgery. A
contralateral fibular flap has the advantage of preserving the contour of the ankle
and reserving the ipsilateral fibula for initial stability at the fusion site. This
study is of level IV evidence.
Keywords osteosarcoma - Ewing's sarcoma - distal tibia - vascularized fibular graft - ankle
arthrodesis
