ABSTRACT
Progressive valgus ankle deformity is a problematic postoperative donor-site morbidity
of a vascularized fibular graft in children. To prevent this complication, tibiofibular
metaphyseal synostosis (the Langenskiöld procedure) has been recommended. The authors
objectively evaluated the preventive and therapeutic effects of this procedure on
five children who had received free vascularized fibular grafts. Their average age
at the time of operation was 3 years (range: 1 to 9 years). The Langenskiöld procedure
was performed primarily in four patients, and not in one patient. The anteroposterior
(A-P) mortise angle and the empirical axis of the donor-site ankle were measured radiographically.
With regard to the A-P mortise angle, four of five patients showed valgus with a mild
lateral wedging of the distal tibial epiphysis. The patient who did not receive the
operation showed the largest A-P mortise angle and mild osteoarthritic changes. The
empirical axis exceeded normal range in all of the five patients. These observations
indicated that valgus deformity of the ankle in children after harvesting a vascularized
fibular graft is inevitable, even if the Langenskiöld procedure is performed. The
procedure can delay the ankle valgus. The authors recommend close follow-up of the
children who receive the Langenskiöld procedure after harvesting a vascularized fibular
graft.
KEYWORD
Vascularized fibular graft - valgus deformity - ankle - donor-site morbidity
