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Fibular hemimelia


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Fibular hemimelia

  1. 1.  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
  2. 2.  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
  3. 3.  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
  4. 4.  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
  5. 5.  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
  6. 6.  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
  7. 7. Type 2 deformity -Complete absence of the fibula.
  8. 8.  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
  9. 9.  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.
  10. 10.  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
  11. 11.  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