Fibular Hemimelia: Reconstruction of Difficult Cases with Tibial Lengthening and Ankle Arthrodesis

Overview

Journal Int Orthop

Specialty Orthopedics

Date 2024 May 7

PMID 38713286

Authors

Surender Singh Yadav

Affiliations

Soon will be listed here.

Abstract

Purpose: Management of fibular hemimelia includes either prosthetic care with or without a suitable amputation or tibial lengthening. Many studies have documented the success of both procedures. Most parents of these children refuse an amputation or have no access to good prosthetic care. The author presents a limb-salvage procedure with tibial lengthening and ankle stabilization.

Methods: Twelve children of fibular hemimelia with 14 extremities had been subjected to limb lengthening after lateral leg release. To correct the valgus procurvatum, double oblique diaphyseal osteotomy (DODO) of the tibia was performed in 11 extremities. The age of the patients ranged from two to 15 years with the median of five years. All were male. The proposed procedure included three stages of loosening, lengthening, and stabilization with ankle arthrodesis at a later stage.

Results: All patients returned for follow-up for the first four years and had been walking on their sensate feet. With DODO followed by fixator/traction could straighten and lengthen the tibia simultaneously and correct the valgus procurvatum. Ankle stabilization provided stability and a plantigrade foot. A follow-up of six to 30 years with a median of ten years has been reported.

Conclusion: A new procedure of loosening, lengthening, and stabilization of the leg with ankle arthrodesis has been proposed. A follow-up of 30 years with a median of ten years of the said procedure has been reported. The procedure provides a long-lasting plantigrade and painless foot that has sensation and proprioception. An amputation at any level has not been recommended.

References

DURAISWAMI P . Experimental causation of congenital skeletal defects and its significance in orthopaedic surgery. J Bone Joint Surg Br. 1952; 34-B(4):646-98. DOI: 10.1302/0301-620X.34B4.646. View

COVENTRY M, JOHNSON Jr E . Congenital absence of the fibula. J Bone Joint Surg Am. 1952; 34 A(4):941-55. View

Achterman C, Kalamchi A . Congenital deficiency of the fibula. J Bone Joint Surg Br. 1979; 61-B(2):133-7. DOI: 10.1302/0301-620X.61B2.438260. View

Birch J, Lincoln T, Mack P, Birch C . Congenital fibular deficiency: a review of thirty years' experience at one institution and a proposed classification system based on clinical deformity. J Bone Joint Surg Am. 2011; 93(12):1144-51. DOI: 10.2106/JBJS.J.00683. View

Stanitski D, Stanitski C . Fibular hemimelia: a new classification system. J Pediatr Orthop. 2002; 23(1):30-4. View

Paley D . Surgical reconstruction for fibular hemimelia. J Child Orthop. 2016; 10(6):557-583. PMC: 5145840. DOI: 10.1007/s11832-016-0790-0. View

Birch J, Walsh S, Small J, Morton A, Koch K, Smith C . Syme amputation for the treatment of fibular deficiency. An evaluation of long-term physical and psychological functional status. J Bone Joint Surg Am. 1999; 81(11):1511-8. DOI: 10.2106/00004623-199911000-00002. View

Naudie D, Hamdy R, Fassier F, Morin B, Duhaime M . Management of fibular hemimelia: amputation or limb lengthening. J Bone Joint Surg Br. 1997; 79(1):58-65. DOI: 10.1302/0301-620x.79b1.6602. View

McCarthy J, Glancy G, Chnag F, Eilert R . Fibular hemimelia: comparison of outcome measurments after amputation and lengthening. J Bone Joint Surg Am. 2000; 82(12):1732-5. DOI: 10.2106/00004623-200012000-00006. View

10.

Patel M, Paley D, Herzenberg J . Limb-lengthening versus amputation for fibular hemimelia. J Bone Joint Surg Am. 2002; 84(2):317-9. DOI: 10.2106/00004623-200202000-00021. View

11.

Gibbons P, Bradish C . Fibular hemimelia: a preliminary report on management of the severe abnormality. J Pediatr Orthop B. 1996; 5(1):20-6. View

12.

Miller L, BELL D . Management of congenital fibular deficiency by Ilizarov technique. J Pediatr Orthop. 1992; 12(5):651-7. View

13.

Catagni M, Bolano L, Cattaneo R . Management of fibular hemimelia using the Ilizarov method. Orthop Clin North Am. 1991; 22(4):715-22. View

14.

Choi I, Kumar S, Bowen J . Amputation or limb-lengthening for partial or total absence of the fibula. J Bone Joint Surg Am. 1990; 72(9):1391-9. View

15.

Cheng J, Cheung K, Ng B . Severe progressive deformities after limb lengthening in type-II fibular hemimelia. J Bone Joint Surg Br. 1998; 80(5):772-6. DOI: 10.1302/0301-620x.80b5.8475. View

16.

Fulp T, Davids J, MEYER L, Blackhurst D . Longitudinal deficiency of the fibula. Operative treatment. J Bone Joint Surg Am. 1996; 78(5):674-82. DOI: 10.2106/00004623-199605000-00006. View

17.

Yadav S . Double oblique diaphyseal osteotomy. A new technique for lengthening deformed and short lower limbs. J Bone Joint Surg Br. 1993; 75(6):962-6. DOI: 10.1302/0301-620X.75B6.8245092. View