Longitudinal overgrowth of the femur stimulated by short-leg ambulation in unilateral partial tibia hemimelia

Abstract

In the treatment of unilateral partial tibia hemimelia, complications from extensive lengthening to correct the marked shortening and recurrent failures of foot reconstructions do not allow limb salvage. Treatment by amputation with prosthetic replacement predominates. Very often, however, amputation is rejected by patients. A case we treated in infancy by complete reconstruction without lengthening walked full weight bearing on the short leg. Twelve years later, the ipsilateral femur manifested 6 cm overgrowth to reduce the shortening. Stimulation of accelerated growth in the partial tibia hemimelia limb by axial-directed stress of short-leg ambulation is suggested by this report, and its implication for enduring limb salvage is discussed.

Deformity Reconstruction Surgery for Tibial Hemimelia

“…The leg length discrepancy in tibial hemimelia typically remains proportional over time; thus, the final predicted leg length discrepancy can be calculated to help families make educated decisions [88,89]. However, it is interesting to note that one case report described significant femoral overgrowth of 6 cm after reconstruction without lengthening, which the authors attribute to stimulation of axial-directed stresses of short-leg ambulation [90]. Staged lengthenings allow trained surgeons to achieve 5-8 cm of lengthening using external fixation.…”