fibula osteotomy

Except for the humerus, the 5cm section of the iliac crest is necessary for the stabilization of the ankle joint, and the rest is available for transplantation. Because the position of the tibia is relatively superficial, straight, no curvature, and the humeral head is similar to the lower end of the humerus. Therefore, autologous iliac bone graft can be used as a bone graft in addition to long bone bone fracture, but also in the long bone defect and the lower end of the humerus. It can be replaced by a iliac bone graft or a bone graft with a humeral head. Defective long tube bone and lower end of the tibia. Treatment of diseases: bone defects Indication Long bone defect and lower end of the humerus. Preoperative preparation The end of the swelling is called the fibular head, which is accessible from the surface of the skin. There is an articular surface on the upper part of the small head and the joint surface outside the upper end of the humerus. The lower part of the small head is called the humeral neck. Surgical procedure 1. Position: supine position, heighten the buttocks; or lateral position, take the bone side up. The thigh is controlled by an inflatable tourniquet. 2. Incision, revealed: a straight incision on the posterolateral side of the calf, starting from the outer iliac crest 10 cm, along the posterior border of the humerus to the humeral head. The fascia is cut, the tibia muscle is separated from the soleus muscle, the periosteum is cut, and the periosteum is peeled off from the distal end to the proximal end to expose the humeral shaft. 3. Bone: The whole bone graft or bone graft is more than 1/3 of the bone in the tibia. The length of the bone is taken as needed, and then cut with a wire saw at both ends; or the circular hole is drilled first, then the bone knife is used. Cut off to avoid splitting the humerus. If it is a whole bone graft, the removed bone segment can be wrapped with saline gauze and transferred to the receiving area. For bone grafting, the removed bone segment should be sawed in half with a chainsaw, or drilled and then opened with an osteotome. If you need to take the upper part of the humerus (including the head), the incision needs to be extended up to 6cm on the knee. The common peroneal nerve was found in the posterior aspect of the biceps femoris and isolated and protected. The nerve descends around the neck of the humerus and then enters the deep side of the long bone of the humerus. In order to avoid injury, the muscle should be separated at the starting point of the humeral head, and the common peroneal nerve can be pulled forward with the long bone of the humerus. The biceps femoris and the lateral collateral ligament are then cut off to stop the upper end of the humerus. Then, according to the required length, drill holes in the backbone to cut the tibia. Clamp the broken end and peel off the interosseous membrane close to the bone surface. Be careful not to damage the anterior tibial artery and vein that pass between the tibia neck and the tibia. Then the sacral, anterior and posterior ligaments of the humeral head are cut off, and the upper part of the humerus can be removed. The removed tibia is properly kept for later use. 4. Stitching: After taking the bone in the middle part of the humerus, suture the gap between the soleus muscle and the long bone of the tibia. After taking the upper part of the humerus, the biceps tendon and the lateral collateral ligament of the severed ligament are sutured to the periosteum or nearby soft tissue on the lateral side of the tibial plateau under appropriate tension to restore the origin of the iliac crest and the common peroneal nerve. . Loosen the tourniquet, stop the bleeding completely, and then suture it layer by layer. complication The medial edge of the body is sharp, called the interosseous margin, and there is adhesion of the calf interosseous membrane. At the midpoint of the medial side, there is a nourishing hole that opens upward. The lower end is also slightly enlarged, called the external hemorrhoid, which can be seen on the body surface. The inner surface of the lateral malleolus has a triangular joint surface, and the joint surface at the lower end of the humerus forms a joint socket, which is associated with the talus.