Remodeling of the Fibula Stump After Transtibial Amputation

Figures & data

Figure 1 Histotopograms of peroneal stump ends (haematoxylin and eosin staining. x2.5): (A) Cylindrical shape with formation of bone closure plate from mature bone tissue; (B) Cone-shaped with congestion of the medullary canal (a) and a small periosteal regenerate (b); (C) Cone-shaped with occlusion of the medullary canal (a), violation of the integrity of the cortical diaphyseal layer (arrow); (D) Club-shaped with full length occlusion of the medullary canal with dense fibrous tissue (a), endosteal-periosteal regenerate at the end (b); (E) Club-shaped: resorption of the cortical diaphyseal plate and its replacement by endosteal-periosteal regenerate (a); endosteal bone beams (b); spongy cortical diaphyseal plate in the proximal region (c); fibrous cartilaginous tissue edging the end of the stump (d).

Figure 2 Microphotograph. Dystrophic changes and necrosis of bone tissue. Haematoxylin and eosin staining. x120.

Figure 3 Мicrophotograph. Spongy tissue of periosteal regenerate bordered by hyaline cartilage. Haematoxylin and eosin staining. x90.

Figure 4 Microphotograph. Dissolution of bone beams of cancellous bone (a) bone-cartilaginous regenerate and its replacement by fibrous tissue (b). Haematoxylin and eosin staining. x130.

Figure 5 Microphotograph. An area of active osteoclastic resorption of compact bone. Haematoxylin and eosin staining. x120.

Figure 6 Microphotograph. Resorption of compact bone tissue. Full blood vessels. Haematoxylin and eosin staining. x80.

Table 1 Quantitative Evaluation of the Tissue Structures of the Amputation Stump of the Fibula

Observations	Tissue Stuctures, %
	Osteogenic, M±SD	Chondrogenic, M±SD	Fibrogenic, M±SD
І group (n=30)	89.13±5.24	3.07±2.68	7.8±3.65
II group (n=18)	73.33±5.58	11.92±3.41	17.49±3.04
IІІ group (n=20)	73.95±4.63	16.15±3.91	8.71±3.04
Significance degree (p-value)	p˂0.001	p˂0.001	p˂0.001
F - Fisher’s criterion, actual	75.3011	83.8624	19.2367
F - Fisher’s criterion, critical	3.1381
	Pairwise comparison
PІ,ІІ	˂0.05	˂0.05	˂0.05
PІ,ІІІ	˂0.05	˂0.01	˃0.05
PІІ,ІІІ	˃0.05	˃0.05	˂0.05

Table 2 Indicators of the Average Time of Prosthesis Use in Patients of the Study Groups Before and After Surgery

Indicators	І Group (n=15)		ІІ Group (n=15)		ІІІ Group (n=15)
	Before Surgery	After Surgery	Before Surgery	After Surgery	Before Surgery	After Surgery
ATPU during the day, hours (M±SD)	10.4±2.61	11.36±0.89	6.09±1.38	10.79±1.70	7.17±1.52	10.81±0.82
Abnormalities of ATPU during the day after surgery to the preoperative period, hours	0.96		4.7		3.64
Improvement dynamics,%	9.23		77.17		50.77
Variation coefficient (Vσ), %	15.0	8.0	18.67	7.12	16.59	8.11
Significance degree (p-value)	P=0.0568		p˂0.001		p˂0.001
F - Fisher’s criterion, actual	3.9468		107.3455		84.6259
F - Fisher’s criterion, critical	4.1959