Outcome of limb lengthening in fibular hemimelia and a functional foot

Abstract

Background The decision to recommend either reconstructive or ablative surgery to the parents of children with fibular hemimelia is difficult and debatable in the orthopaedic literature.

Internal Lengthening Device for Congenital Femoral Deficiency and Fibular Hemimelia

“…Limb lengthening in patients with congenital limb deficiency has been a challenge for surgeons; most studies to date have used external fixation for this purpose, which is associated with many complications such as pin tract infection, poor regenerate formation, preconsolidation, pain and refractures [3,7,8,15,23,26,39]. To our knowledge, the safety and effectiveness of using an intramedullary lengthening device in patients with congenital shortening have not been previously studied.…”

“…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]. Lengthening in congenitally short limbs is challenging, characterized by a high number of surgical procedures and associated with many complications, such as residual leg length discrepancy (LLD), delayed union, poor regenerate formation, bone preconsolidation, ankle and knee stiffness, refractures, joint subluxation/dislocation, and residual sagittal and coronal deformity [1,3,5,7,8,15,23,26]. Additionally, the rates are as high as 96% for superficial pin site infection and 20% for deep infection [2,13].…”

Reconstruction of the lateral malleolus in a type-Ib fibular hemimelia with a microvascular proximal fibular flap

“…When three or more rays of the foot are present, a plantigrade foot can be achieved with tibial lengthening and tibiotalar arthrodesis [4]. Softtissue releases alone have yielded poor results, and supramalleolar varus osteotomies are only indicated in the less severe cases [7].…”

“…There is still some debate on reconstruction versus amputation for the severe type Ib and type II cases [2,3]. Limb-length discrepancy can be corrected with Ilizarov methods, but ankle stability remains a problem [3][4][5]. The absence of the lateral malleolus destabilizes the mortise in valgus and ankle fusion is usually needed.…”

Asimetría de extremidades inferiores: Evaluación por imágenes en la edad pediátrica

“…La hipoplasia peronea o hemimelia fibular (Figura 3), es la deficiencia que afecta más comúnmente a los huesos largos e incluye un amplio espectro que abarca desde el discreto acortamiento del peroné hasta su completa ausencia (11) .…”