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Complete fibular hemimelia: a long-term review of four cases
J Tomás-Gil1, D Valverde Belda, J Chismol-Abad
1Department of Orthopedic Surgery, Dr. Peset University Hospital, Valencia, Spain. tomas_jju@gva.es
Insights
Fibular hemimelia, a common congenital limb defect, often requires complex treatment. For Type II fibular hemimelia, early amputation may offer better outcomes than limb lengthening.
Area of Science:
- Orthopedics
- Pediatric Orthopedics
- Congenital Limb Deformities
Background:
- Fibular hemimelia is the most frequent congenital defect of long bones, affecting the fibula, tibia, femur, and foot.
- It is the most common skeletal deformity observed in the lower limbs.
- This condition involves partial or total aplasia of the fibula.
Purpose of the Study:
- To evaluate treatment outcomes for total fibular aplasia.
- To compare the efficacy of tibial lengthening versus amputation for Type II fibular hemimelia.
Main Methods:
- Retrospective study of four patients (3 males, 1 female) with total fibular aplasia.
- Average follow-up period of 15 years.
- Analysis of treatment strategies including successive tibial lengthenings and Syme amputation.
Main Results:
- Three patients underwent multiple tibial lengthening surgeries with numerous complications.
- One patient treated with Syme amputation had a single operation without complications.
- The amputated case demonstrated a simpler and complication-free recovery.
Conclusions:
- Early amputation is suggested as the preferred treatment for Type II fibular hemimelia.
- Surgical outcomes indicate that amputation may be superior to limb lengthening in specific cases.
- This finding challenges traditional approaches and advocates for earlier surgical intervention.
Abstract:
Fibular hemimelia is a partial or total aplasia of the fibula, and is usually associated with other anomalies of the tibia, femur and foot. It represents the most frequent congenital defect of the long bones and is the most common skeletal deformity in the lower limbs. A retrospective study was made of four patients (three males and one female) with total aplasia of the fibula. The average follow-up was 15 years. Three patients were treated by successive tibial lengthenings; in one case amputation was carried out using the Syme technique. Lengthening required numerous operations and led to many complications, whereas the amputated case involved a single surgical operation without complications. The results of our cases and those reported in the literature suggest early amputation as the treatment of choice of Type II fibular hemimelia.