Abstract
Introduction: The usual clinical presentation of fibular hemimelia is of leg discrepancy, an equinovalgus deformity of the foot, ankle instability and the absence of the lateral rays of the foot. The aim of this study is to evaluate the results of ankle joint reconstruction, using remnants of the fibula, fibular analge or contra lateral fibular graft, in conjunction with the Ilizarov Technique.
Methods: Thirteen limb segments in 12 patients with fibular hemimelia were reviewed, with an average age of 4.7 years. According to Catagni’s classification 2 limbs were type I, 1 limb was type II and 10 limbs were type III. The ankle joint was reconstructed using remnants of the fibula if present in type I, fibular analge or a contra lateral fibular graft. The Ilizarov technique was the used to correct limb length discrepancy and any concomitant deformities.
Results: The functional outcome was assessed by the ability to undertake daily activities. All cases were clinically examined and the satisfaction of the patients and family were assessed. A satisfactory stability of the ankle foot complex was achieved in all patients. The average lengthening achieved using the frame was 5.6 cm and all limbs were equalized to within 2 cm of the contralateral side.
Discussion: Reconstruction of the ankle joint brings the foot into a good position, preserves the ankle joint motion, facilitates fitting shoes and stabilizes the joint in a more normal position compared to distal tibial osteotomies. The Ilizarov technique corrects the concomitant deformity and achieves a near normal limb length. The combination of both techniques provides a better outcome compared to other treatment modalities.
Correspondence should be addressed to BSCOS, c/o Royal College of Surgeons, 35 – 43 Lincoln’s Inn Fields, London, WC2A 3PN
