Knee Pain
Benjamin Apichai in Chinese Medicine for Lower Body Pain, 2021
The lower leg is made up of two bones, the tibia and fibula. The fibula is the slender one and posterolaterally situated to the tibia. It is a non-weight-bearing bone. These two bones are connected at two locations: Proximal tibiofibular joint—the fibula articulates with the inferior aspect of the lateral tibial condyle. It is supported by a tense joint capsule; the capsule attaches to the tibia and fibula at the margin of the articular surface and is reinforced anteriorly by the biceps femoris tendon insertion into the fibular capitulum, posteriorly by the popliteus tendon, superiorly by the lateral collateral ligament, and inferiorly by the interosseous membrane.Distal tibiofibular joint—the fibula articulates with the fibular notch of the tibia.
The Musculoskeletal System and Its Disorders
Walter F. Stanaszek, Mary J. Stanaszek, Robert J. Holt, Steven Strauss in Understanding Medical Terms, 2020
The large bone located above the knee in the leg is the femur. The tibia is the largest bone below the knee, located in front of the fibula. The ankle bones or tarsals, the foot bones or metatarsals (literally, "after the tarsals"), and the toe bones or phalanges (singular: phalanx) complete the lower extremity. The upper extremity is composed of the collar bone or clavicle, which articulates with the wingbone or scapula, the long bone of the upper arm known as the humerus, the radius and ulna below the elbow and joining the wrist bone or carpais, the bones of the hand or metacarpals, and the phalanges of the fingers.
Fibular flap
John Dudley Langdon, Mohan Francis Patel, Robert Andrew Ord, Peter Brennan in Operative Oral and Maxillofacial Surgery, 2017
The fibula is a long slender triangular-shaped bone that is said to have two functions: ankle joint stability and microvascular reconstruction of bony defects. It is mainly composed of cortical bone, giving it great stability. The advantages of the fibula are that it offers an abundant supply of tubed bi-cortical bone, which is useful for reconstruction of long segmental defects across the midline – 25 cm or more of bone can be harvested. There is usually little morbidity at the donor site, and it is highly reliable with a 95% success rate (when used, the skin paddle component is reported to be less reliable). It is also possible to harvest the fibula simultaneously with the tumour resection as no change in the patient’s position is required. Bone height is the main potential disadvantage, especially when reconstructing the dentate mandible. To overcome this problem, the osteotomized fibula can be folded back onto itself whilst maintaining intact soft tissue and periosteum on one side (‘double barrelling’). Distraction osteogenesis, followed by implant placement, can also give a very good result (Figure 27.1). It is usual to leave the flap for several months before distraction, to allow bony union with the recipient bed and enable the fixation plates to be removed.
Combined massive allograft and intramedullary vascularized fibula transfer: the Capanna technique for treatment of congenital pseudarthrosis of the tibia
Published in Acta Orthopaedica, 2020
Stefanie C M Van Den Heuvel, Hay A H Winters, Klaas H Ultee, Nienke Zijlstra-Koenrades, Ralph J B Sakkers
Patient 3 had bilateral ipsilateral vascularized fibula transfers. The distal anastomosis of the left tibia fractured after 15 months. Fusion by creating a synostosis between the distal tibia and distal remnant fibula segment was not successful at the first attempt and the patient chose to have an amputation and below-knee prosthesis. Her mobility with the below-knee prosthesis increased to such a level that she fractured the earlier operated right leg at the level of the distal screw of the LCP plate. The fracture healed after removing the LCP plate, drilling both distal tibia and fibula, and using a large spongiosa graft from a Reamer Irrigator Aspirator (RIA; DePuy Synthes, Warsaw, IN, USA) procedure from the ipsilateral femur. Latest follow-up showed a bony crossover between the distal tibia and the distal fibula.
Hemi-tibia allograft and free microvascularized fibula transplant reconstitute the tibia shaft with side to side healing: 7 year follow up of a 14-year-old boy with adamantinoma
Published in Case Reports in Plastic Surgery and Hand Surgery, 2021
Alexander P. Decilveo, Melissa S. Liebling, Andrew L. Golden, James C. Wittig
The patient was treated with radical resection of the right tibia shaft and reconstructed with a hemi-tibia shaft fresh-frozen allograft and free microvascular fibula transplant. Through a medial approach to the leg, a total of 19 cm of the tibia with 2 cm margins at the proximal and distal end was removed. A free vascularized fibula was harvested from the contralateral limb in a manner that its length would permit direct contact or overlap with the tibia proximally and distally. The graft was prepared with preservation of the peroneal vessels, which were later anastomosed to proximal branches of the posterior tibial artery. No skin island was used as an implanted pulse oximeter ensured patency of the anastomosis. The allograft used was a fresh frozen tibia that approximated the patient’s size (Bone Bank Allografts, San Antonio, TX). The tibia allograft was then cut longitudinally approximately 50% of its circumference to enable space for the free vascularized fibula to be recessed. The hemi-tibia allograft was fixated to the native bone with two pelvic reconstruction plates that were contoured for placement. The fibular autograft was lagged to native bone distally and allograft proximally. The contact between the free fibula and native tibia as well as the space between fibula and allograft were supplemented with a mixture of iliac crest autograft and cortico-cancellous bone allograft.
A new standard radiographic reference for proximal fibular height in children
Published in Acta Orthopaedica, 2020
Adrien Frommer, Maike Niemann, Georg Gosheger, Gregor Toporowski, Andrea Laufer, Maria Eveslage, Jan Niklas Bröking, Robert Rödl, Bjoern Vogt
Standard radiographic references of joint and limb alignment are of fundamental importance for the treatment of limb deformities and leg-length discrepancies. Various studies have improved the field of deformity reconstruction by providing radiological reference values to distinguish between physiological and pathological limb alignment (Moreland et al. 1987, Chao et al. 1994, Paley 2002). When considering the lower leg, previous studies have mainly assessed the radiological location of the distal fibula in relation to the ankle joint. Ogden and McCarthy (1983) have shown that during adolescence the distal fibular physis is normally level with the tibial articular surface of the ankle joint. The Shenton line and dime sign are radiographic measurements that have been described in order to analyze the relationship of the distal fibula and distal tibia (Panchbhavi et al. 2018).
Related Knowledge Centers
- Ankle
- Bone
- Malleolus
- Tibia
- Leg
- Knee
- Interosseous Membrane
- Syndesmosis
- Superior Tibiofibular Joint
- Plane Joint