A rare variant of tibial hemimelia and its treatment

Shrivastava, Sandeep; Nawghare, Shishir; Dulani, Rajesh; Singh, Pradeep K; Jain, Shudhatma

doi:10.1097/bpb.0b013e32832e4737

Cited by 8 publications

(9 citation statements)

References 11 publications

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“…Our case neither conforms to any of the 4 types of Jones’ classification, nor the Weber- classification or Paley- classification. Shrivastava [10] present a variant of tibial hemimelia in 2009, which was very similar to our case. That case was a 9-year-old Asian boy who was diagnosed with tibial hemimelia when he was 1 week old, because of the absence of tibia shaft, fibular become hypertrophied, shortened and curved after loading the body weight.…”

Section: Discussionsupporting

confidence: 88%

Asymmetric limb lengthening in the treatment of tibial hemimelia caused by osteomyelitis

Yu²,

Deng³

et al. 2019

Medicine

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Section: Discussionsupporting

confidence: 88%

Asymmetric limb lengthening in the treatment of tibial hemimelia caused by osteomyelitis

Yu²,

Deng³

et al. 2019

Medicine

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“…One example is the case report by Shrivastava et al of an intercalary deficiency where the central portion of the tibia is missing but the proximal and distal tibia is intact [50]. …”

Section: Classificationmentioning

confidence: 99%

Tibial hemimelia: New classification and reconstructive options

Paley¹

2016

Journal of Children's Orthopaedics

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Tibial hemimelia is a rare congenital lower limb deficiency presenting with a wide spectrum of associated congenital anomalies, deficiencies and duplications. Reconstructive options have been limited, and the gold standard for treatment has remained amputation with prosthetic fitting. There is now a better understanding of the genetics, etiology and pathoanatomy of tibial hemimelia. Armed with this knowledge, I present here a new classification to guide treatment and prognosis and then discuss new treatment strategies and techniques for limb reconstruction based on this new classification scheme.

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“…It has been suggested that treatment should start as early as possible in order to achieve early and maximum alignment between the knee and the ankle 5,17,30 . Various reconstructive methods have been described to avoid amputation 1,12,19,24,27,30 . Brown, in 1965, described the cases of 3 patients who were managed with fibular centralization combined with arthrodesis of the knee and Syme amputation 1 .…”

Section: Discussionmentioning

confidence: 99%

“…Tibial hemimelia is a rare congenital anomaly that may be associated with other congenital anomalies, deficiencies, and duplications 1-12 . The spectrum of pathological findings is much wider, and nearly 60% of patients with tibial hemimelia have other associated congenital anomalies such as lobster claw deformity, hand syndactyly, polydactyly, and/or foot ray duplication 6-8,13,14 .…”

mentioning

confidence: 99%

Type-I Tibial Hemimelia

Yadav

2019

JBJS OA

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Background: Tibial hemimelia is a rare but disabling condition. Although reconstructive methods have been described, the recommended treatment typically has been amputation at various levels followed by the use of a suitable prosthesis. A new technique known as femoro-fibulo-calcaneal arthrodesis has been developed as a limb-salvage procedure for patients with type-I deficiency who refuse amputation or have no access to good prosthetic care. Methods: Twelve children (18 extremities) with type-I tibial hemimelia were managed surgically. The ages of the patients at the time of surgery ranged from 2 to 14 years. The procedure includes 3 stages: loosening, lengthening, and stabilization. In all patients, the loosening stage involved release of soft-tissue contractures at both ends of the fibula. The lengthening stage involved either supervised lengthening at home with use with use of an external fixator (6 patients) or the use of traction in the hospital (6 patients). In all patients, the stabilization stage was subsequently performed by stabilizing the fibula to the femoral condyles proximally and the talus distally with use of crossed Kirschner wires. Results: All 12 patients returned for follow-up for the first 5 years. All patients were evaluated by author. Two patients who had ipsilateral femoral focal deficiency were subsequently lost to follow-up. The remaining 10 patients were followed for a mean of 10 years (range, 5 to 32 years). All 10 patients were able to walk on their feet during follow-up. None of the patients in the present study had an amputation or needed a prosthesis. There were no major complications. Conclusions: A new procedure, femoro-fibulo-calcaneal arthrodesis, has been proposed for the treatment of type-I tibial hemimelia. The suggested procedure is simple, biological, cost-effective, and dependable. It provides a long-term stable and functional extremity that enables the patient to walk with plantigrade feet with sensation and proprioception. This limb-saving procedure should be considered as an alternative for patients who refuse to lose the limb or for whom good prosthetic care is unavailable. Level of Evidence: Therapeutic Level IV . See Instructions for Authors for a complete description of levels of evidence.

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A rare variant of tibial hemimelia and its treatment

Abstract: Tibial hemimelia is a rare condition. We present a variant of tibial hemimelia not reported in literature before. In this variant, we were able to successfully salvage the limb with excellent function to carry on with life.

Cited by 8 publications

References 11 publications

Asymmetric limb lengthening in the treatment of tibial hemimelia caused by osteomyelitis

Asymmetric limb lengthening in the treatment of tibial hemimelia caused by osteomyelitis

Tibial hemimelia: New classification and reconstructive options

Type-I Tibial Hemimelia

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