Fibular aplasia. Early surgical correction in two cases
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1Orthopädische Universitätsklinik Balgris, Zürich, Switzerland.
Insights
Surgical correction of bilateral fibular aplasia in infants can restore functional ambulation. Conservative treatments, including soft tissue release and osteotomies, enable walking without orthotics, offering an alternative to amputation.
Area of Science:
- Orthopedic surgery
- Pediatric orthopedics
- Congenital limb differences
Background:
- Bilateral fibular aplasia is a rare congenital condition affecting lower limb development.
- Management typically involves complex reconstructive procedures or amputation.
- Early intervention is crucial for optimizing functional outcomes.
Observation:
- Two infants diagnosed with bilateral fibular aplasia underwent surgical intervention at 8 months and 1.5 years of age.
- Procedures aimed to achieve a stable axial foot position under the tibia.
- Surgical techniques included soft tissue releases, tibial angulation osteotomies, and distal tibial epiphyseal splitting.
Findings:
- Both patients achieved successful functional ambulation.
- Patients can walk effectively barefoot or with custom footwear.
- No orthotic devices were required post-operatively.
Implications:
- Conservative surgical management is a viable alternative to amputation for selected cases of bilateral fibular aplasia.
- These techniques can lead to excellent functional recovery and improved quality of life.
- Further research into long-term outcomes of such conservative approaches is warranted.
Abstract:
Two infants with bilateral fibular aplasia are described. They were operated on at 1 1/2 years and 8 months respectively in order to obtain a stable axial position of the foot beneath the tibia. The procedures consisted of soft tissue releases together with angulation osteotomies of the tibiae in one, and splitting the distal tibial epiphysis in the other. Both patients are now able to walk well barefoot or in custom-made shoes; no orthotic devices are needed. This type of conservative approach should be considered rather than amputation in selected cases.