Staged Reconstruction of Post-traumatic Medial Malleolus Bone Defects Using Fibular Head Osteochondral Graft: A Report of Two Cases

ABSTRACT

Aim

The aim of this study was to report a novel technique for reconstruction of post-traumatic medial malleolar bone defects, by the use of fibular head osteochondral grafting.

Background

Severe open ankle injuries involving loss of bone and soft tissue are challenging entities to treat. There are very few reports in literature on reconstruction of post-traumatic medial malleolar bone loss, and they predominantly describe the use of a composite vascularized pedicle-based flap.

Case description

We report two cases of post-traumatic medial malleolar fractures with bone and soft tissue loss, and ankle instability, managed by staged anatomic reconstruction using autologous ipsilateral fibular head osteochondral grafts without a composite vascular pedicle-based flap, following primary soft tissue reconstruction and ankle-spanning external fixation. At 2 years’ follow-up, both patients had good functional outcomes with a stable, painless ankle joint and were able to ambulate unaided. They had no donor site morbidity. Both patients had nearly normal plantar flexion, while one had restriction of dorsiflexion. Radiographs showed bony union and graft incorporation with no signs of graft resorption or secondary ankle arthritis.

Conclusion

The use of fibular head osteochondral grafts for reconstruction of medial malleolar bone loss is a simpler alternative to microsurgical osseous reconstruction using vascular pedicle-based composite flaps in the management of complex ankle injuries with medial malleolar bone loss, and yields good mid-term results.

Clinical significance

Fibular head osteochondral grafting of medial malleolar bone defects could be a useful tool in the armamentarium of the trauma surgeon, especially at smaller trauma care centers, where access to infrastructure or a surgeon skilled and experienced in performing vascularized grafts is limited.

How to cite this article

Ramanujapuram S, Parameswaran A. Staged Reconstruction of Post-traumatic Medial Malleolus Bone Defects Using Fibular Head Osteochondral Graft: A Report of Two Cases. J Foot Ankle Surg (Asia-Pacific) 2023;10(1):33-37.