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Assessing Valgus Deformity of the Ankle in Children Following a Free Fibular Graft Harvest

Grant Recipient: Carley Vuillermin, MBBS, FRACS

Co-Investigators: Peter Waters, MD; Collin May, MD
Boston Children's Hospital
Presentations & Publications:
Further Funding:
Additional Information:
Study Aims:
Aim 1: To assess valgus deformity of the ankle using radiographic measures the tibial talar angle and distal tibial fibular physes difference.
Hypothesis: Langenskiold procedures will prevent the development of progressive ankle valgus secondary to free fibular harvests in previously healthy ankles.
Progress has been made over the past year towards our primary goal of comparing the outcomes of our two cohorts of patients: 60 patients who have undergone a free fibular harvest only and 17 patients who have undergone a Langenskiold procedure in addition to a free fibular harvest. Retrospective research has been completed on the Langenskiold, free fibula patient cohort and nears completion on the non-Langenskiold group. In the next year, we plan to begin the prospective outreach to patients in order to obtain new radiographs from patients willing to participate in the prospective arm of the study. The prospective phase of the study is being completed after retrospective data collection is complete per IRB request.
Aim 2: To describe the use of the free fibula in a pediatric tertiary care center
Hypothesis: Free fibular grafts are harvested to be used for three main purposes: upper extremity reconstructions, femoral head reconstructions and oncology reconstructions.
Progress has been made over the past year towards our secondary goal through our retrospective data collection. A summary of the data collected so far, including a summary of the recipient sites for free fibular grafts, is included in Table 1 below.
Aim 3: To assess the long term patient reported outcomes of patients who have undergone a free fibular graft harvest.
            Hypothesis: Ankle valgus will be correlated with lower FAAM scores and lower OxAFQ-C scores.
IRB approval has been obtained for the prospective arm of the study. However, per IRB request, the prospective phase of the study will be started after retrospective data collection is complete. We plan to initiate the prospective phase of this study including the PRO’s in the near future.
Table 1. Summary of Data Collected as of 5/31/19 
Demographics N (%)
Age at surgery (y) Mean = 10.66
Gender – Female 77 (45.5)
Primary Operations Performed  
    Langenskiold + Free Fibula 54 (40.7)
    Free Fibula Only 54 (59.3)
Fibular Graft for Reconstruction  
    Upper Extremity 7 (19.4)
    Femoral Head 7 (19.4)
    Oncological Site To be collected

Expenditures: The table below is a summary of grant expenses through May 31, 2019.
Expense Category Spent Remaining
BCH Research Coordinator    
Salary    1,000 0
TOTAL    1,000 0