Limb Salvage Treatment for Congenital Deficiency of the Tibia

Abstract

Nine limb salvage treatments were performed in 7 patients with congenital deficiency of the tibia. All feet showed equinovarus deformity and were centralized in a slightly equinus position by placing the distal end of the fibula into the posterior facet of the calcaneus. Tibiofibular fusion was performed in 4 patients with partial deficiency, and fibular transfer (fibular centralization; Brown procedure) in 5 with complete deficiency of the tibia. Callus distraction lengthening was performed repeatedly for leg-length discrepancy on either the femur or the centralized fibula. Satisfactory functional and cosmetic results were obtained in all limbs with partial deficiency, whereas in limbs with completely deficiency, none of the 5 knees treated by fibular transfer achieved a satisfactory functional result because of insufficient quadriceps strength, progressive knee flexion contracture, and persistent ligamentous instability. Nevertheless, in these 5 cases, all patients were ultimately able to withstand weight-bearing.

Case Reports: Lengthening of a Vascularized Free Fibular Graft

“…LLD in CTD is always important. The reported amounts lengthened ranged from 2 to 15 cm [17,22,42], with callus distraction initiated at a rate of 0.75 mm per day [42] or 1 mm per day [17]. The healing index was approximately 1 cm per month in all cases.…”

“…As suggested, a distraction rate of 0.75 or 1 mm per day is appropriate for CPT [42], however Ilizarov et al [21] recommended a lower distraction rate (0.5 mm per day) for humeral lengthening to obtain good consolidation of the regenerate. In our patients, the average healing index was 25 days per cm (range, 21-25 days/cm), which is similar to published results [1,21,34].…”

“…Lengthening procedures in Kalamchi Types 1 and 2 [24] CTD must be distinguished. In Type 1, the osteotomy is performed in the centralized fibula [42], whereas in Type 2, it is performed in the persistent proximal tibia [17,22]. These two different types of reconstructions of CTD are equivalent to partial or complete tibial defect reconstruction with FVFG.…”

“…There are no guidelines for a lengthening procedure of a FVFG, but progressive fibular lengthening, as a single weightbearing bone, has been described after congenital tibial deficiency (CTD) reconstruction [42]. Lengthening procedures in Kalamchi Types 1 and 2 [24] CTD must be distinguished.…”

Ectromelia totale di tibia: ricostruzione del ginocchio

“…D'altro canto, la correzione chirurgica risulta difficoltosa e richiede un lungo periodo di trattamenti cruenti e incruenti con risultati definitivi non sempre soddisfacenti. Sono infatti necessari più interventi per correggere le deformità a carico del ginocchio e della caviglia e per allungare l'arto durante l'accrescimento [5][6][7][8]. L'esame della letteratura evidenzia che i risultati sono soddisfacenti nei casi in cui sia presente una porzione prossimale della tibia, in quanto il ginocchio è completamente formato.…”