Peroneal Nerve Dysfunction in Proximal Fibular Epiphyseal Harvesting Cases

In children the preserved epiphysis of the proximal fibula ensure the exceptional ability to recover both joint function and longitudinal limb growth at the same time. Traumatic bone defect, congenital malformations, malignant bone lesions and infection are all current indications for VFET. The shape and size of the proximal fibular epiphysis aid in the gradual remodeling of the articular surface, allowing for better reconstruction and eventual rehabilitation over time.

Harvesting the proximal epiphysis of the fibula, along with its intact blood supply, is technically demanding, and the success of VFET is a primarily dependent on restoring adequate vascularity to the growth plate and diaphysis.

Anterior tibial artery is the primary and most consistent contributor to the proximal fibular epiphysis and proximal two thirds of diaphysis, it has intimate connection to the motor (deep) branch of peroneal nerve. The success of anterior tibial artery based VFET based on preserving the anterior tibial Vascular bundle, so it may be necessary to sacrifice some branches of peroneal nerve to tibialis anterior muscle. This is a significant flaw in the approach that could result in permanent peroneal nerve palsy.