Limb length discrepancy and congenital limb anomalies in fibular hemimelia

Abstract

The aim of this study was to determine the prevalence of ipsilateral congenital musculoskeletal anomalies associated with fibular hemimelia. We also attempted to determine the corelation between the eventual limb length discrepancy at maturity and these associated anomalies, as well as the Achterman-Kalamchi class of these patients. The records and roentgenograms of 45 patients with fibular hemimelia were reviewed retrospectively. All patients were classified into three groups (types I-A, I-B, and II) according to the Achterman-Kalamchi system. The prevalence of congenital limb anomalies, lower extremity discrepancy percentage, and ultimate limb length discrepancy at skeletal maturity were evaluated. There was no significant statistical association between the number of congenital limb anomalies and severity of the limb length discrepancy, but patients included in the mildly affected group (type I-A) had a higher average prevalence of congenital limb anomalies than those classified as types I-B and II. There was a substantial correlation between congenital short femur as well as the Achterman-Kalamchi classification system and the predicted limb length discrepancy. A similar percentage of limb length discrepancy in types I-B and II was seen. In conclusion, the numbers of associated congenital limb anomalies are not predictive of the eventual limb length discrepancy. Presence of a congenital short femur and ball and socket ankle are predictive of a higher limb length discrepancy. Achterman-Kalamchi types I-B and II show a similar percentage of limb length discrepancy and this is significantly higher than that seen in type I-A.

Internal Lengthening Device for Congenital Femoral Deficiency and Fibular Hemimelia

“…Congenital femoral deficiency and fibular hemimelia are found to be associated in the same limb in about 68% of cases [32]. Both can present with a broad spectrum of severity, from mild cases to severe manifestations such as acetabular dysplasia, femoral shortening, genu valgus, anteromedial bowing of the tibia, absent ACL, balland-socket ankle, tarsal coalition, and absence of lateral toes [4,38].…”

The Nature of Foot Ray Deficiency in Congenital Fibular Deficiency

“…In several large studies, the incidence of foot ray deficiency has ranged between 44% and 69%. 6,18,19 Much of literature describes it as a "lateral ray deficiency." [1][2][3][4][5][6][7][8][9][10][11][12] However, some of the earliest descriptions of congenital fibular deficiency described the associated foot ray deficiencies as "central."…”

“…Of these 58 patients, 12 were excluded because they had 5-rayed feet (ie, no ray deficiency), 19 were excluded because the bones of their feet were not sufficiently ossified for adequate evaluation, and 1 patient was excluded because there was only a lateral radiograph available. A total of 26 patients (with 28 affected limbs with reduced number of metatarsals) met the inclusion criteria for the study.…”

Hemiepiphysiodesis for Correction of Angular Deformity in Pediatric Amputees

“…The physiological ligament laxity seen in children, as well as the insufficient knee ligaments seen in this particular patient population, 21,22 allows them to rotate their entire limb through either the hip or knee joint to compensate for worsening angular deformity and hide it in their prosthesis. The physiological ligament laxity seen in children, as well as the insufficient knee ligaments seen in this particular patient population, 21,22 allows them to rotate their entire limb through either the hip or knee joint to compensate for worsening angular deformity and hide it in their prosthesis.…”