Fibular hemimelia, also known as congenitalabsence of the fibula, congenital deficiency of thefibula, paraxial fibular hemimelia, and aplasia orhypoplasia of the fibula, is the most common longbone deficiency
Some have recently postulated that interferencewith limb-bud development plays an important rolein postaxial hypoplasia of the lower extremity. During the fetal period, the fibular field of the limbbud controls development of the proximal femur,explaining the frequent association of femoralabnormalities
Involved limb is usually shortened, and the foot is inequinovalgus position Classically the skin has dimpling seen over the tibia Clinically, primary problems related to fibularhemimelia are limb length inequality and foot/ankleinstability
Proximal femoral focal deficiency (PFFD) Coxa vara Femoral hypoplasia with external rotation Lateral patella subluxation Hypoplastic lateral femoral condyle Genu valgus with lateral mechanical axisdisplacement
Flattened tibial eminence with absent cruciate anda positive Lachman sign Short and/or bowed tibia Equino valgus at ankle Ball-and-socket ankle Absent tarsal bones Tarsal coalitions Absent foot rays
Type 1 deformity -hypoplasia of the fibula Type 1A- The proximal fibular epiphysis is distalto the proximal tibial epiphysis and the distalfibular epiphysis is proximal to the talar dome. Type 1B- The deficiency of the fibula is moresevere, with 30% to 50% of the length missingand no distal support for the ankle joint
Type 2 deformity -Complete absence of the fibula.
The goals of treatment are equalization of limblength and correction of the foot deformity Conservative management- No treatment orthe use of heel lifts may be adequate, particularlyin discrepancies less than 2 cm
Epiphysiodesis of the normal leg is performedat the appropriate time so that leg lengths areequal at the end of skeletal growth Gruca procedure- Rarely is indicated andshould be used only when the foot is to besalvaged and the ankle requires stabilization.
Syme’s Amputation and prostheticrehabilitation- When limb-length discrepancy ispredicted to be more than 12 to 15 cm and thefoot is deformed. The advantages of early amputation include fewerhospitalizations and surgical procedures. Childrenwho undergo amputation at an early age showexcellent emotional adaptation to their disabilityand have good functional results
Both posterior and lateral releases are required. The tendo calcaneus, as well as thefibrocartilaginous anlage of the absent fibula, mustbe released Ankle valgus can be corrected with a dome orvarus supramalleolar osteotomy
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