Predictable regeneration and protective effect against ankle valgus following non-vascularized fibular graft harvest in children

Figure 1 Measurement of lateral distal tibial angle. LDTA: Lateral distal tibial angle.

Figure 2 Malhotra grading for paediatric ankle valgus. A: Grade 0: Fibular physis at or below the level of the tibial plafond; B: Grade 1: Fibular physis between plafond and distal physis of tibia; C: Grade 2: Fibular physis at the level of distal tibial physis; D: Grade 3: Fibular physis above the distal tibial physis. The degree of ankle valgus is determined based on the level of the fibular physis.

Figure 3 Serial radiograph of lower limb where bilateral fibula was harvested for spinal fusion surgery. A: Preoperative; B: Immediate postoperative; C: 3 months post-surgery; D: 6 months post-surgery; E: Antero-posterior and Lateral radiograph of bilateral leg taken at final follow-up showing complete union. AP: Antero-posterior; Preop: Preoperative; Post-op: Post-operative.

Figure 4 Plain radiograph of a patient where fibula failed to unite initially but achieved complete regeneration at one year follow up. A: Preoperative; B and C: Radiograph taken at 6 months showing incomplete regeneration; D and E: One year post surgery radiograph showing complete regeneration. Preop: Preoperative; Post-op: Post-operative.

Figure 5 One and a half years follow-up of a case where long segment graft harvest from bilateral fibula shows failure to achieve complete regeneration at final follow-up. A: Preoperative; B: Immediate post-operative; C: 6 months follow-up; D: Final follow-up. Serial plain radiograph taken at preoperative, immediate post op, 6 months follow-up, final follow-up. Preop: Preoperative; Post-op: Post-operative.