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Sen S, Kar A, Das A, Naik B. Excision of a Distal Tibial Interosseous Osteochondroma Through Posterolateral Approach: A Case Report. Cureus 2024; 16:e59592. [PMID: 38832143 PMCID: PMC11144583 DOI: 10.7759/cureus.59592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/02/2024] [Indexed: 06/05/2024] Open
Abstract
Osteochondromas arising from the interosseous border of the distal tibia are rare, but cases have been reported previously in the literature. In long-standing cases, they can cause a "mass effect" resulting in the deformation of the bones around the ankle joint, mechanical restriction of joint movement, and even degenerative joint disease. Hence, they need to be resected if patients present with such impending complications. Several surgical techniques have been described previously for tumor resection including the anterior approach and the trans-fibular approach, the latter of which required a fibular osteotomy with or without fibular reconstruction. The surgical technique described here utilizes the posterolateral approach to the ankle joint for tumor excision, thus avoiding the need for any osteotomy or fibular reconstruction and reducing the risk of injury to major neurovascular structures. It also reduces the need for long-term immobilization and promotes a faster return to activity.
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Affiliation(s)
- Soumyadip Sen
- Orthopaedics, Apollo Multispeciality Hospitals, Kolkata, IND
| | - Abheek Kar
- Orthopaedics, Apollo Multispeciality Hospitals, Kolkata, IND
| | - Abhishek Das
- Orthopaedics, Apollo Multispeciality Hospitals, Kolkata, IND
| | - Balesh Naik
- Orthopaedics, Apollo Multispeciality Hospitals, Kolkata, IND
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Liu S, Hu Y, Yang R, Sun H. Loop plate elastic fixation of distal tibiofibular syndesmosis in treating distal tibia osteochondroma: A technique note. Asian J Surg 2023; 46:5976-5978. [PMID: 37704477 DOI: 10.1016/j.asjsur.2023.09.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 09/01/2023] [Indexed: 09/15/2023] Open
Affiliation(s)
- Sanmao Liu
- Department of Hand and foot microsurgery, Central Hospital of Dalian University of Technology, Dalian City, Liaoning Province, China; School of Graduates, Dalian Medical University, No.9, West Section of South Lvshun Road, Dalian City, Liaoning Province, 116000, China
| | - Yunxiang Hu
- Department of Hand and foot microsurgery, Central Hospital of Dalian University of Technology, Dalian City, Liaoning Province, China; School of Graduates, Dalian Medical University, No.9, West Section of South Lvshun Road, Dalian City, Liaoning Province, 116000, China
| | - Rui Yang
- Department of Hand and foot microsurgery, Central Hospital of Dalian University of Technology, Dalian City, Liaoning Province, China; School of Graduates, Dalian Medical University, No.9, West Section of South Lvshun Road, Dalian City, Liaoning Province, 116000, China
| | - Huanwei Sun
- Department of Hand and foot microsurgery, Central Hospital of Dalian University of Technology, Dalian City, Liaoning Province, China.
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Tosun B, Selek O. Lateral Transfibular Approach to Tibial Pilon Fractures: A Case Report. J Am Podiatr Med Assoc 2019; 109:459-462. [PMID: 31755769 DOI: 10.7547/17-212] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
We present a case of tibial pilon fracture where only the lateral part of the distal tibia was affected. The transfibular approach to the ankle was used for the surgical treatment of the fracture. After an initial nonweightbearing period of 3 weeks, full weightbearing was allowed 8 weeks after surgery. The second-year follow-up showed no evidence of degenerative signs, with full ankle range of motion.
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Affiliation(s)
- Bilgehan Tosun
- Department of Orthopaedics and Traumatology, Kocaeli University, School of Medicine, Izmit, Kocaeli, Turkey
| | - Ozgur Selek
- Department of Orthopaedics and Traumatology, Kocaeli University, School of Medicine, Izmit, Kocaeli, Turkey
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Appy-Fedida B, Krief E, Deroussen F, Plancq MC, Collet LM, Klein C, Gouron R. Mitigating Risk of Ankle Valgus From Ankle Osteochondroma Resection Using a Transfibular Approach: A Retrospective Study With Six Years of Follow-Up. J Foot Ankle Surg 2017; 56:564-567. [PMID: 28268141 DOI: 10.1053/j.jfas.2017.01.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2015] [Indexed: 02/03/2023]
Abstract
To prevent worsening of ankle valgus and functional repercussions, a distal inter-tibiofibular osteochondroma can be removed using a transfibular approach. We evaluated the difference between the preoperative and postoperative tibiotalar tilt at the last follow-up examination and the clinical and radiologic outcomes. We included 10 consecutive ankles that had undergone removal of an osteochondroma using a transfibular approach. The mean patient age was 10.6 years. One ankle was lost to follow-up. The mean postoperative follow-up duration was 5.9 years. The mean preoperative and postoperative tibiotalar tilt was 7.2° and 7.1°, respectively, with no significant difference. The mean postoperative American Orthopaedic Foot and Ankle Society score was 92.4. Tibiofibular synostosis developed in 7 cases. Osteochondroma recurred in 1 case. The transfibular approach stabilizes ankle valgus and is associated with good functional outcomes. However, it is an extensive procedure associated with postoperative synostosis and, thus, should be considered primarily when surgical access for an anterior approach is limited.
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Affiliation(s)
- Benjamin Appy-Fedida
- Surgeon, Department of Pediatric Orthopaedic Surgery, Amiens University Hospital and Jules Verne University of Picardie, Amiens, France
| | - Elie Krief
- Surgeon, Department of Pediatric Orthopaedic Surgery, Amiens University Hospital and Jules Verne University of Picardie, Amiens, France
| | - François Deroussen
- Surgeon, Department of Pediatric Orthopaedic Surgery, Amiens University Hospital and Jules Verne University of Picardie, Amiens, France
| | - Marie-Christine Plancq
- Surgeon, Department of Pediatric Orthopaedic Surgery, Amiens University Hospital and Jules Verne University of Picardie, Amiens, France
| | - Louis-Michel Collet
- Professor, Department of Pediatric Orthopaedic Surgery, Amiens University Hospital and Jules Verne University of Picardie, Amiens, France
| | - Céline Klein
- Surgeon, Department of Pediatric Orthopaedic Surgery, Amiens University Hospital and Jules Verne University of Picardie, Amiens, France
| | - Richard Gouron
- Professor, Department of Pediatric Orthopaedic Surgery, Amiens University Hospital and Jules Verne University of Picardie, Amiens, France.
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Distal tibial osteochondroma causing fibular deformation resected through a posterolateral approach. CURRENT ORTHOPAEDIC PRACTICE 2016. [DOI: 10.1097/bco.0000000000000351] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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The utility and limitations of the transfibular approach in ankle trauma surgery. Case Rep Orthop 2014; 2014:234369. [PMID: 25530896 PMCID: PMC4230000 DOI: 10.1155/2014/234369] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2014] [Accepted: 10/07/2014] [Indexed: 11/25/2022] Open
Abstract
The commonly used extensive approaches to the distal tibia include the posteromedial and anterolateral approaches. The current report describes several cases performed using this technique establishing a rationale and safe zone for performing a transfibular approach to the distal tibia. The advantages of such approach are the excellent visualization of the lateral tibia and the articular space. The utilization of this approach involves the risk of injury to the anterior tibial vessels and to the superficial peroneal nerve as well as a requirement for syndesmosis reconstruction. The recommendation is to utilize this approach in cases of severe comminution of the lateral tibia with a relatively intact medial tibia.
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Osteochondromas around the ankle: Report of a case and literature review. Int J Surg Case Rep 2013; 4:1025-7. [PMID: 24096194 PMCID: PMC3825984 DOI: 10.1016/j.ijscr.2013.08.015] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2013] [Revised: 07/17/2013] [Accepted: 08/06/2013] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION An osteochondroma or exostosis is a benign bone tumour consisting of a bony outgrowth covered by a cartilage cap that occurs commonly in the metaphysis of long bones, mainly the distal femur, proximal tibia and proximal humerus. PRESENTATION OF CASE We describe an unusual case of a distal tibia osteochondroma affecting the lateral malleolus of a young girl. DISCUSSION Most osteochondromas are asymptomatic and seen incidentally during radiographic examination. Osteochondromas are rarely localized in the foot and ankle. CONCLUSION Although most of the osteochondromas in children should be treated conservatively until skeletal maturity, those affecting the distal tibia or fibula should be treated with surgical excision in order to prevent ankle deformity, syndesmotic lesions or even fracture due to the expanding nature of this benign tumour.
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Wani IH, Sharma S, Malik FH, Singh M, Shiekh I, Salaria AQ. Distal tibial interosseous osteochondroma with impending fracture of fibula - a case report and review of literature. CASES JOURNAL 2009; 2:115. [PMID: 19187551 PMCID: PMC2646691 DOI: 10.1186/1757-1626-2-115] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/05/2009] [Accepted: 02/02/2009] [Indexed: 11/10/2022]
Abstract
Osteochondromas arising from the interosseous border of the distal tibia and involving distal fibula are uncommon. We present a 16 year old young boy with an impending fracture, erosion and weakness of the distal fibula, secondary to an osteochondroma arising from the distal tibia. Early excision of this deforming distal tibial osteochondroma avoided the future risk of pathological fracture of the distal fibula, ankle deformities and syndesmotic complications.
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Affiliation(s)
- Iftikhar H Wani
- Postgraduate Boys Hostel Room No 215 B, Government Medical College Bakshi Nager, Jammu, Jammu and Kashmir, India.,Postgraduate Department of Orthopaedics, Government Medical College, Jammu, Jammu and Kashmir, India
| | - Siddhartha Sharma
- Postgraduate Boys Hostel Room No 215 B, Government Medical College Bakshi Nager, Jammu, Jammu and Kashmir, India.,Postgraduate Department of Orthopaedics, Government Medical College, Jammu, Jammu and Kashmir, India
| | - Farid H Malik
- Postgraduate Boys Hostel Room No 215 B, Government Medical College Bakshi Nager, Jammu, Jammu and Kashmir, India.,Postgraduate Department of Orthopaedics, Government Medical College, Jammu, Jammu and Kashmir, India
| | - Manjeet Singh
- Postgraduate Boys Hostel Room No 215 B, Government Medical College Bakshi Nager, Jammu, Jammu and Kashmir, India.,Postgraduate Department of Orthopaedics, Government Medical College, Jammu, Jammu and Kashmir, India
| | - Irfan Shiekh
- Postgraduate Boys Hostel Room No 215 B, Government Medical College Bakshi Nager, Jammu, Jammu and Kashmir, India.,Postgraduate Department of Orthopaedics, Government Medical College, Jammu, Jammu and Kashmir, India
| | - Abdul Q Salaria
- Postgraduate Boys Hostel Room No 215 B, Government Medical College Bakshi Nager, Jammu, Jammu and Kashmir, India.,Postgraduate Department of Orthopaedics, Government Medical College, Jammu, Jammu and Kashmir, India
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Fibular lengthening by Ilizarov method secondary to shortening by osteochondroma of distal tibia. Strategies Trauma Limb Reconstr 2008; 3:45-8. [PMID: 18427924 DOI: 10.1007/s11751-007-0028-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2007] [Accepted: 12/10/2007] [Indexed: 10/22/2022] Open
Abstract
Osteochondroma is the most common benign bone tumour. They most commonly affect the long tubular bones and almost half of osteochondromata are found around the knee. Osteochondroma arising from the distal metaphysis of the tibia typically result in a valgus deformity of the ankle joint secondary to relative shortening of the fibula. This case describes the use of Ilizarov technique for fibular lengthening following excision of a distal tibial osteochondroma. A 12-year-old girl presented with a 3-year history of a large swelling affecting the lateral aspect of the right distal tibia. Plain radiographs confirmed a large sessile osteochondroma arising from the postero-lateral aspect of the distal tibia with deformity of the fibula and 15 mm of fibular shortening. The patient underwent excision through a postero-lateral approach and subsequent fibular lengthening by Ilizarov technique. The patient made excellent recovery with removal of frame after 21 weeks and had made a full recovery with normal ankle function by 6 months. The Ilizarov method is a commonly accepted method of performing distraction osteogenesis for limb inequalities; however, this is mainly for the tibia, femur and humerus. We are unaware of any previous cases using the Ilizarov method for fibular lengthening. This case demonstrates the success of the Ilizarov method in restoring both fibular length and normal ankle anatomy.
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Gil-Albarova J, Gil-Albarova R, Bregante-Baquero J. Fibular rotational osteotomy for the treatment of distal tibial osteochondroma: a technical modification for deformity correction and improved outcomes. J Foot Ankle Surg 2007; 46:474-9. [PMID: 17980846 DOI: 10.1053/j.jfas.2007.08.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2006] [Indexed: 02/03/2023]
Abstract
The technique of choice for excision of osteochondromas located in the lateral aspect of the tibia is a transfibular approach to expose the lesion for resection. A drawback of this approach is that removal of the lesion leaves a void that may cause a visible deformity and adversely affect long-term function. Fibular rotational osteotomy followed by fibular graft may minimize the resultant deformity, producing a more satisfactory functional and cosmetic result. The authors report a retrospective case series consisting of 5 cases in which a fibular graft rotation was performed after rotational osteotomy via a transfibular approach. Retrograde intramedullary fixation by means of a Kirschner wire, in combination with the design of the fibular osteotomy, provided rotational graft and fibular stability until healing occurred.
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Affiliation(s)
- Jorge Gil-Albarova
- Servicio de Cirugía, Ortopédica y Traumatología, Hospital Universitario Miguel Servet, Zaragoza, Spain.
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