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Outcomes and Complications of Fibular Head Resection

By Dr. Dinesh K Agarwal

, Dr. S Saseendar

, Dr. Dilip K Patro

, Dr. Jagdish Menon

Submited on: 04 Dec 2011 09:36:05 PM GMT

Published on: 05 Dec 2011 08:43:29 AM GMT

Does the donor site morbidity restrict us in taking Fibular graft?

Posted by Dr. Sujit K Tripathy on 06 Dec 2011 11:41:04 PM GMT

1	Is the subject of the article within the scope of the subject category?	Yes
2	Are the interpretations / conclusions sound and justified by the data?	Yes
3	Is this a new and original contribution?	No
4	Does this paper exemplify an awareness of other research on the topic?	Yes
5	Are structure and length satisfactory?	Yes
6	Can you suggest brief additions or amendments or an introductory statement that will increase the value of this paper for an international audience?	Yes
7	Can you suggest any reductions in the paper, or deletions of parts?	No
8	Is the quality of the diction satisfactory?	Yes
9	Are the illustrations and tables necessary and acceptable?	Yes
10	Are the references adequate and are they all necessary?	Yes
11	Are the keywords and abstract or summary informative?	Yes

Other Comments:
A good informative paper on fibular graft donor site morbidity, but it would have been better if the authors could have gather some more information abot the patients, for example, a radiographic evaluation of the distal fibular remnants for corelation of its osteoporotic/ penic changes with the length. Similarly, patient's activity level, weight (obesity) and any other associated joint comorbidities evalaution might have provided a better conclusion. The authors found varus laxity of the knee in most of their patients. I personally believe that adequacy of repair of the fibular collateral ligament and biceps femoris to the softtissues/ tibial metaphysis is one of the major predictors of this outcome. In fact for most of these metaphyseal benign or aggressive tomors, a modified malabar resection has been described, in whcih the metaphyseal part of fibula is resected preserving the proximal head part to keep the lateral restraints inatct. Other than these few limitations, the article seems to be satisfactory.
Competing interests:
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Have you previously published on this or a similar topic?:
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Adequate
How to cite: Tripathy S K.Does the donor site morbidity restrict us in taking Fibular graft?[Review of the article 'Outcomes and Complications of Fibular Head Resection ' by Menon J].WebmedCentral 2011;2(12):WMCRW001212

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We thank Dr Tripathi for his comments on the article. The present study was a retrospective study with follow-up of the patients during the study. Though assessment of bone density of the remaining fibula and its correlation with length could add to some detail, resection of the fibula is a relatively rare procedure and a larger sample size would be required to study such a correlation or to assess a relation with body mass index or patient activity level. Also the varying patient age group precluded studying an association. Regarding the incidence of varus laxity, the lateral collateral ligament was in fact attached to the adjacent soft tissues in the patients of the present study. However it is the opinion of the authors that a more secure attachment of the ligament to the bone could possibly reduce the incidence of such varus laxity. Nevertheless a well planned comparative study would be required to assess the superiority of one procedure over the other. Though the authors agree that modified Malabar resection would allow preserve the attachments of the lateral stabilisers, the indications for fibular head resection in the present study warranted complete resection of the proximal part of the fibula and hence the lateral stabilisers had to be reattached. Though resection of the fibular head may not be avoided in circumstances as in tumors or autologous bone grafting of a resected distal radius, the present study attempts to highlight the problems that may arise out of such a procedure and discusses ways that could avoid these issues. We appreciate Dr Tripathy's efforts to review the article and raise these points.
Responded by Dr. S Saseendar on 02 Mar 2012 11:48:45 AM

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