Original articleEmerged donor limb growth morbidity and malalignment after combined ipsilateral tibial and fibular cortical harvest graft in children. Early follow-up reportDeo, Nitish Bikram; Agarwal, Anil Author Information Department of Paediatric Orthopaedics, Chacha Nehru Bal Chikitsalaya, Delhi, India Received 15 November 2022 Accepted 26 December 2022. Correspondence to Anil Agarwal, MS, Department of Paediatric Orthopaedics, Chacha Nehru Bal Chikitsalaya, 4/103, East End Apartments, Mayur Vihar Ph-1 Ext., Delhi-110096, India, Tel: +91 98 1029 0295; e-mail: [email protected] Journal of Pediatric Orthopaedics B ():10.1097/BPB.0000000000001059, January 19, 2023. | DOI: 10.1097/BPB.0000000000001059 Buy PAP Metrics Abstract The quantity of bone grafts required in certain pediatric conditions is sometimes substantial. This retrospective study details the radiological changes occurring in the donor leg and ankle following the simultaneous harvest of large diaphyseal cortical grafts from the tibia and fibula in 14 children (16 legs). The following preoperative and follow-up radiological parameters were measured and compared for donor legs: the longitudinal continuous regeneration of fibula, distal fibular station, medial proximal tibial angle, lateral distal tibial angle, posterior proximal tibial angle (PPTA), anterior distal tibial angle and interphyseal angle (tibia diaphyseal angulation) in both coronal and sagittal planes. Additionally, the impact of fibular regeneration in combined harvests was separately analyzed. Children were operated at the mean age of 52 months. Mean follow-up of 25.2 months was available. At follow-up, the donor tibia healed completely in all legs whereas fibular regeneration was complete only in 10 legs (62.5%). At follow-up, ankle valgus was present in 6 out of 16 legs (37%) and tibia valga increased in all legs except one (94%). Procurvatum was present in 7 legs. The fibular nonregeneration group was prone to ankle valgus deformity (P = 0.014), valgus angulation of tibial diaphysis (P = 0.0076) and lower mean PPTA (P = 0.026) when compared to the regenerate group. There was a complication of stress fracture in one donor tibia. Combined tibial and fibular harvest is a major surgical undertaking in children. The donor limbs have their share of complications postharvest, more so when the fibula remains nonregenerated. Serial monitoring of donor sites is emphasized. Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.