Congenital Fibular Deficiency

Birch, John G.; Lincoln, Todd L.; Mack, Philip W.; Birch, Craig

doi:10.2106/jbjs.j.00683

Cited by 74 publications

(19 citation statements)

References 45 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Some surgeons consider absence of two or more metatarsals an indication for amputation [13]. My results do not support this [21, 35, 36].…”

Section: Methodsmentioning

confidence: 84%

“…In such situations, amputation is contraindicated. Finally, when there are upper extremity deficiencies, which make independently getting in and out of a prosthetic challenging, amputation is also contraindicated [13]. …”

Section: Discussionmentioning

confidence: 99%

“…Therefore, a classification based on the foot deficiency is needed. Birch et al [13] classified FH according to the number of rays of the foot and recommended amputation for most cases with less than three rays.

Fig. 1Paley classification of fibular hemimelia (FH).…”

Section: Classification Of Fh (Fig 1)mentioning

confidence: 99%

See 2 more Smart Citations

Surgical reconstruction for fibular hemimelia

Paley¹

2016

Journal of Children's Orthopaedics

View full text Add to dashboard Cite

Fibular hemimelia presents with foot deformity and leg length discrepancy. Previous classifications have focused on the degree of fibular deficiency rather than the type of foot deformity. Published methods of surgical reconstruction have often failed due to residual or recurrent foot deformity. The purpose of this report is to introduce new classification and reconstruction methods. The Paley SHORDT procedure is used to stabilize the ankle when there is a hypoplastic distal fibula with a dynamic valgus deformity. It involves shortening and realignment of the distal tibia relative to the fibula. In contrast, the Paley SUPERankle procedure is used when there is a fixed equinovalgus foot deformity. The SUPERankle uses a supramalleolar shortening-realignment osteotomy and/or subtalar osteotomies with anlage resection. Due to the bony instead of soft tissue correction of deformity, residual or recurrent deformity is prevented. Weakening of gastro-soleus and peroneal muscles is avoided by shortening of the tibia instead of tendon lengthening. The limitation of ankle motion is related to ankle dysplasia rather than surgery or lengthening. A plantigrade-stable foot and ankle leads to an excellent functional result comparable or better than a Syme’s amputation with prosthetic fitting. Serial lengthening procedures combined with the SHORDT or SUPERankle reconstruction lead to limb length equalization with a plantigrade, painless, functional foot.

show abstract

“…Some surgeons consider absence of two or more metatarsals an indication for amputation [13]. My results do not support this [21, 35, 36].…”

Section: Methodsmentioning

confidence: 84%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Surgical reconstruction for fibular hemimelia

Paley¹

2016

Journal of Children's Orthopaedics

View full text Add to dashboard Cite

show abstract

“…The Birch classification is primarily based on the existence of a functional foot, and secondarily on the amount of a limb shortening [8, 9]. No information about the degree of fibular shortening is taken into consideration in this classification system.…”

Section: Discussionmentioning

confidence: 99%

Intermediate ray deficiency—a new type of lower limb hypoplasia

et al. 2012

View full text Add to dashboard Cite

ObjectiveDiagnosis of fibular hemimelia is based on the identification of absence or shortening of the fibula in relation to the tibia. Despite the existence of different classifications of this congenital deficiency, certain morphological forms defy proper classification. One such form is absence of foot rays with leg shortening in the presence of an entire fibula. In these cases, foot morphology suggests that central foot rays, not lateral ones, are affected by the deficiency; thus justifying the hypothesis concerning the existence of a separate type of hypoplasia, which may be named “intermediate ray deficiency” (IRD).Materials and methodsNine patients with IRD, with an average age of 9.4 years at diagnosis (2.9–15), were analyzed. Clinical and radiographic parameters of the leg and foot were recorded according to the Stanitski classification of fibular hemimelia. The position of the lateral and medial malleoli was assessed. Axial alignment was analyzed according to the Paley method.ResultsThe number of foot rays in eight cases was 4, while in one case, it was 3. Talocalcaneal synostosis was observed in seven cases. The shape of the ankle joint was spherical in six cases, horizontal in two cases and valgus in one case. The position of the lateral malleolus was slightly higher compared to normal. An average functional leg length discrepancy was 4.4 cm. The average percentage of fibular shortening was 9.5 %, tibial shortening 8.7 % and femoral shortening 3.3 %. In all of the cases, slight knee valgus was observed on the femoral level (average 3.3°) and tibial level (average 2.0°). As a result, criteria for IRD diagnosis were proposed.Conclusion“Intermediate ray deficiency” might be defined as a separate type of lower limb hypoplasia.

show abstract

“…As the fibula normally contributes to the structure and stability of the lateral part of the ankle joint, its absence in conjunction with absent or insufficient ligaments in the ankle and knee, particularly the anterior cruciate ligament, can significantly affect joint stability and therefore may affect lower limb function and participation in daily activities [7]. It is commonly associated with an equinovalgus [2,3,6,8,9,10,11,12,13] or equinovarus [3,6,9,10] foot, in addition to lateral ray deficiencies, tarsal coalition, anteromedial bowing of the tibia, genu valgum, hypoplastic patella, cruciate ligament deficiency [9,13], and femoral shortening.…”

Section: Introductionmentioning

confidence: 99%

Longitudinal Fibular Deficiency: A Cross-Sectional Study Comparing Lower Limb Function of Children and Young People with That of Unaffected Peers

et al. 2019

View full text Add to dashboard Cite

Longitudinal fibular deficiency (LFD), or fibular hemimelia, is congenital partial or complete absence of the fibula. We aimed to compare the lower limb function of children and young people with LFD to that of unaffected peers. A cross-sectional study of Australian children and young people with LFD, and of unaffected peers, was undertaken. Twenty-three (12 males) children and young people with LFD (74% of those eligible) and 213 unaffected peers, all aged 7–21 years were subject to the Knee Osteoarthritis Outcome Score (KOOS/KOOS-Child) and the Cumberland Ankle Instability Tool (CAIT/CAIT-Youth). Linear regression models compared affected children and young people to unaffected peers. Participants with LFD scored lower in both outcomes (adjusted p < 0.05). The difference between participants with LFD and unaffected peers was significantly greater among younger participants than older participants for KOOS activities and sports domain scores (adjusted p ≤ 0.01). Differences in the other KOOS domains (pain/symptoms/quality of life) and ankle function (CAIT scores) were not affected by age (adjusted p ≥ 0.08). Children and young people with LFD on average report reduced lower limb function compared to unaffected peers. Knee-related activities and sports domains appear to be worse in younger children with LFD, and scores in these domains become closer to those of unaffected peers as they become older.

show abstract

Congenital Fibular Deficiency

Cited by 74 publications

References 45 publications

Surgical reconstruction for fibular hemimelia

Surgical reconstruction for fibular hemimelia

Intermediate ray deficiency—a new type of lower limb hypoplasia

Longitudinal Fibular Deficiency: A Cross-Sectional Study Comparing Lower Limb Function of Children and Young People with That of Unaffected Peers

Contact Info

Product

Resources

About