Successful Midfoot Reconstruction in Müller-Weiss Disease Using a Reverse Fibular Flap: A Case Report and Literature...

Area of Science:

• Orthopedics
• Vascularized bone grafting
• Foot and ankle surgery

Background:

• Müller-Weiss disease (MWD) is a degenerative condition affecting the navicular bone, causing chronic midfoot and hindfoot pain.
• Etiology is uncertain, often involving navicular dysplasia, osteochondritis, or trauma, with limited treatment options beyond conservative care.
• Surgical interventions like joint fusion are considered for refractory cases, but outcomes for complex non-unions with bone defects are poorly documented.

Observation:

• A 52-year-old female patient with a history of MWD experienced persistent pain and navicular necrosis after a failed talonavicular fusion.
• The patient had no history of trauma or neurological issues, highlighting the idiopathic nature of her MWD progression.
• Radiographs revealed significant lateral navicular necrosis and navicular-cuneiform arthritis, indicating advanced disease progression.

Findings:

• A novel surgical technique combining a reverse vascularized pedicled fibular flap with extended midfoot fusion was employed to address the navicular bone defect.
• The patient achieved a virtually pain-free state and returned to work six years post-surgery.
• Radiographic evidence confirmed successful incorporation of the fibular bone graft, indicating successful fusion and defect management.

Implications:

• This case presents the first documented use of a reverse vascularized fibular bone graft for recalcitrant MWD.
• The combined ortho-plastics approach offers a promising solution for complex midfoot non-unions with significant bone defects.
• Surgeons should consider this innovative technique for managing challenging MWD cases unresponsive to conventional treatments.