fibula transfer

Radial metastasis is used for the surgical treatment of congenital tibial defects. Congenital tibial defect is also called paralateral tibia and extremity deformity. It is a rare long bone defect deformity, accounting for 30% of bilateral involvement. The severity of the lesion can range from a complete defect of the tibia to a mild hypoplasia of the tibia. The lesioned calf becomes shorter and can reach the small head of the humerus displaced upward. The affected foot is deformed in a horseshoe varus and the hind foot is stiff. Larger children, even if the X-ray film is unclear, can reach the cartilaginous anlage proximal to the tibia. Knee joints often have flexion contracture. In severe cases, they often lack knee extension because of quadriceps dysfunction. Careful examination of the quadriceps knee extension device is of great significance for evaluating the potential of knee joint reconstruction. The disease can also be complicated by femoral dysplasia. The most widely used classification of congenital tibial defects was proposed by Jones, Barners and Lloyd-Roberts, based primarily on early X-ray findings. 1IA type: dislocation of the humerus to the proximal side, the X-ray film can not show the humerus, the distal femur is smaller than the healthy side; 2IB type: the tibia is dislocated proximally, and the proximal humerus of the humerus can be seen by ultrasound or magnetic resonance imaging, but the X-ray film Can not be displayed; 3 type II: lateral dislocation of the humerus, X-ray film visible proximal humerus and normal knee joint; 4III type: lateral dislocation of the humerus, X-ray film visible distal radius of the humerus without proximal humerus; 5 IV type: humerus Displaced proximally, the distal ankle is separated. The treatment of congenital tibial defects is to restore the length of the limbs, obtain a stable knee joint with a certain active function, and a normal walking foot. But until now, in most patients with such malformations, the main treatment is still amputation and prosthetic limbs to restore function. Surgical treatment depends on its X-ray classification and clinical presentation. Treatment of diseases: lack of congenital tibia Indication Type IA congenital tibial defect below 1 year old (preferably within 6 months) has the potential to walk. There is a functional quadriceps device, and the knee joint can be passively straightened. There is no obvious deformity above the knee, and the humerus has no congenital curvature. Contraindications Those who do not have the surgical prerequisites specified in the indications. Preoperative preparation Prepare routinely before surgery. Surgical procedure Incision Take a semi-circular incision in front of the knee, starting from the outside of the knee joint to the small head of the humerus, extending down to the distal femoral epiphysis, and then to the proximal and medial sides to reveal the entire distal femur. 2. Expose the upper end of the humerus and the femoral condyle In the superficial fascia superficial free flap, the front and the outer side of the knee joint are exposed (Fig. 3.19.1.3.1-2). The lateral support band was cut parallel to the tibia and quadriceps tendon, the patellar ligament was cut, and the fibrous tissue deep in the proximal part of the tibia and the lateral femoral condyle was removed, so that the proximal end of the humerus was completely free and displaced distally and medially. 3. Transfer the humerus to reconstruct the knee joint Cut the proximal humeral head, make the section flat, loosen the soft tissue under the femoral condyle, move the proximal end of the humerus into it, cross-fix with Kirschner wire, so that the tibia and femur longitudinal axis are in the sagittal and coronal planes. Good match. If the humerus is too long, the humerus can be taken for a period of time. The intramedullary fixation is performed with a retrograde nail. When the humeral head is moved under the femoral condyle to form a new joint, the Sterling nail is retrograde into the femoral condyle. . 4. Reconstruct joint capsule and patellar ligament The soft tissue is tightened and sutured to form a tight knee capsule. Maintain a good alignment of the humerus and attach the distal end of the patellofemoral ligament to the proximal end of the humerus to provide a knee extension. 5. Stitching Rinse the wound, completely stop bleeding, suture the skin and skin. complication The main complications of humeral metastases include common peroneal nerve injury, knee flexion contracture, and metastatic dislocation of the tibia. Strictly grasp the surgical indications and intraoperative attention points, to prevent the above complications. For older IA type congenital iliac defect with quadriceps lack and knee flexion contracture, knee dissection should be performed.