Abstract
The purpose of the study was to evaluate the usefulness of the techniques introduced for correction of the deformities associated with fibular hemimelia.
Material. 10 children (6 boys and 4 garils) with affected 11 limbs were analyzed. All presented Achterman-Kalamchi type II fibular hemimelia (absence of the fibula, anterior tibial bowing and hypoplastic foot). Limb length discrepancy ranged from 2 to 9 cm. Only 2 feet had 5 rays, 4 – 4 rays and 5 three rays. In 10 feet talo-calcaneal synostosis was diagnosed intra-operatively. Age at operation ranged from 7 to 23 months (mean 13.2). Follow-up was 4.7 years (1 – 8.5).
Technique. Two groups of patients were analyzed.
The 1st group consisted of 3 children (3 affected limbs) operated on by partial or complete release of the ankle. Correction of the equinus and valgus deformity was possible by rotation of the talus in the ankle joint in coronal and sagittal plain (the oval shape of talar dome allowed its rotation in the ankle joint). In 2 patients the tibial osteotomy were made as a separate procedure.
The 2nd group consisted of 7 children (8 affected limbs) operated on by one-stage technique consisting of (1) trapezoid resection of the tibia for correction of anterior bowing and internal torsion (2) posterior and lateral release of the foot with lengthening of tendo Achilles and peroneals tendons (3) •opening wedge osteotomy through talo-calcaneal synostosis with bone graft taken from the tibia for correction of valgus and equinus deformity (4) skin plasty with subcuteneous flap for wound covering. In this group relationships between talus and tibia were not changed by operation (flat top talus).
Results. Both techniques resulted in stabile and properly aligned tibia and hindfoot. Five children were treated later by Ilizarov method at age of 57 months (53 – 80). Other five patients walked independently in orthopaedic or normal shoes. Two of them wait for limb lengthening. The method used in the 2nd group was especially useful for patients with bilateral deformity. The relapse of hindfoot valgus deformity was observed after limb lengthening.
Conclusion. One-staged correction of the complex deformity in fibular hemimelia is safe and cost effective. The treated limb was properly prepared for lengthening, wear-bearing in shoes (bilateral cases), orthosis or pros-thesis.
Local Host: British Society for Children’s Orthopaedic Surgery. Conference Theme: Congenital Deficiencies of the Lower Limb. These abstracts were prepared by A.Catterall.
