Fibular osteotomy strategies and techniques: A survey of the limb lengthening and reconstruction society membership

Context: Fibular osteotomy is a necessary element of most tibial procedures, but there is no consensus on the ideal location, orientation, or technique for the procedure. Aims: We surveyed limb reconstruction surgeons to learn how often a fibular osteotomy was performed, details of surgical technique, and varying intraoperative parameters. Settings and Design: A cross-sectional survey was sent to all members of the Limb Lengthening and Reconstruction Society – North America, as well as experienced international limb reconstruction surgeons. Subjects and Methods: The survey contained 12 questions regarding fibular osteotomies in the setting of limb reconstruction surgery. Responses were not specific to any particular procedure. Data were collected on how often a fibular osteotomy was performed, details of surgical technique, and varying intraoperative parameters. Statistical Analysis Used: Statistical tests employed include Kruskal–Wallis, Mann–Whitney U, Chi-square, and Fisher's exact tests where appropriate. Results: A total of 149 surveys were returned. Most surgeons perform fibular osteotomy at the junction of middle and distal thirds or in middle third, 36.9% and 31.5%, respectively. The least common location for osteotomy was in the proximal third of fibula (4%). The most common method for creating fibular osteotomy was with an oscillating saw (48.3%), followed by drilling holes and using an osteotome (45.0%). The average reported time for the completion of osteotomy was 13 ± 7.2 min, with shortest average time reported for surgeons who perform osteotomy in the distal third (11.3 ± 6.4 min) and longest for those at proximal third (14.6 ± 10.3 min). The most common closure technique was that of layered closure (97%). Conclusions: Most surgeons perform a transverse osteotomy occurring at the junction of the middle and distal thirds of the fibula. The osteotomy is most commonly performed at the beginning of the case using either an oscillating saw or multiple drill holes and osteotome. Continued research is needed to determine the specific indications for performing a fibular osteotomy, if the anatomic location of the fibula osteotomy is important, and when a segment of the fibula should be removed.