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Predictable regeneration and protective effect against ankle valgus following non-vascularized fibular graft harvest in children
Md Zafar Iqbal, Anil Agarwal, Shivank Khurana, Aakash Deep, Sagarika Sahoo, Department of Paediatric Orthopaedics, Chacha Nehru Bal Chikitsalaya, New Delhi 110031, Delhi, India
Author contributions: Iqbal MZ and Khurana S contributed to the conception and design of the study, patient recruitment, data acquisition, statistical analysis, interpretation of the data, and drafting of the manuscript; Agarwal A contributed to data acquisition, interpretation of results, and critical revision of the manuscript, supervised the study, provided administrative and academic oversight, critically reviewed the manuscript for important intellectual content; Deep A and Sahoo S participated in study design, supervised data collection, interpreted the findings, and critically revised the manuscript; all authors have read and approved the final manuscript, and agree to be accountable for all aspects of the work.
AI contribution statement: No AI tool was used in the preparation of the manuscript.
Institutional review board statement: The study was approved by the Institutional Review Committee, No. 101/269.
Clinical trial registration statement: This study was a prospectively done observational study and not a clinical trial. Hence, we did not register it as clinical trial.
Informed consent statement: All participants provided informed consent.
Conflict-of-interest statement: All authors declare no conflict of interest in publishing the manuscript.
CONSORT 2010 statement: The authors have read the CONSORT 2010 Statement, and the manuscript was prepared and revised according to the CONSORT 2010 Statement.
Data sharing statement: The datasets generated and/or analyzed during the current study are not publicly available due to institutional and patient confidentiality requirements but are available from the corresponding author upon reasonable request.
Corresponding author: Md Zafar Iqbal, Department of Paediatric Orthopaedics, Chacha Nehru Bal Chikitsalaya, Geeta Colony, New Delhi 110031, Delhi, India. docmdzafariqbal@gmail.com
Received: June 23, 2026
Revised: July 21, 2026
Accepted: July 28, 2026
Published online: August 18, 2026
Processing time: 52 Days and 16.8 Hours
Revised: July 21, 2026
Accepted: July 28, 2026
Published online: August 18, 2026
Processing time: 52 Days and 16.8 Hours
Core Tip
Core Tip: Fibular regeneration following non-vascularized fibular graft harvest in children is common when the periosteal sleeve is preserved, with most cases achieving continuity within six months. This prospective study demonstrates that successful regeneration is associated with a substantially lower incidence of ankle valgus deformity, highlighting its protective role in maintaining lateral ankle stability. However, regeneration is not universal, and valgus deformity may occur despite regeneration, emphasizing the need for meticulous surgical technique, preservation of the periosteum, and serial postoperative surveillance of the donor site.