Surgical reconstruction for fibular hemimelia

Area of Science:

• Orthopedic surgery
• Pediatric orthopedics
• Congenital limb deformities

Background:

• Fibular hemimelia causes foot deformities and leg length discrepancies.
• Existing classifications and surgical methods often result in recurrent deformities.
• Novel classification and reconstruction strategies are needed.

Approach:

• Introduced new classification and surgical reconstruction methods for fibular hemimelia.
• Paley SHORDT procedure for dynamic valgus deformity with hypoplastic distal fibula.
• Paley SUPERankle procedure for fixed equinovalgus foot deformity using osteotomies.

Key Points:

• Bony correction prevents residual or recurrent deformities, unlike soft tissue methods.
• Tibia shortening avoids muscle weakening associated with tendon lengthening.
• Achieves a plantigrade, stable, and functional foot and ankle, comparable to amputation.

Conclusions:

• The SHORDT and SUPERankle procedures provide effective bony correction for fibular hemimelia.
• Combined with limb lengthening, these methods achieve equalization and excellent functional results.
• These advancements offer superior outcomes to previous surgical techniques and prosthetic fitting.