Severe tibial growth retardation in total fibular hemimelia after limb lengthening

Seven patients with total fibular hemimelia who underwent limb-lengthening procedures prior to skeletal maturity were evaluated for tibial and femoral growth after lengthening. The average preoperative follow-up was 6.5 years and all patients were followed to skeletal maturity. Thirteen segments (eight tibiae and five femora) were lengthened by three methods (Wagner, Ilizarov, and modified Ilizarov). The average preoperative limb-length discrepancy was 9.7 cm, and the average projected limb-length discrepancy at skeletal maturity was 12.5 cm. The average tibial lengthening was 6.7 cm (range, 5.3-10) with an average percentage of lengthening of 26% (range, 19-40%). The average postoperative growth rate of the tibia was 80% (range, 70-100%) and of the femur, 83% (range, 70-90%) of the normal side. Five tibiae showed a decrease in the average preoperative growth rate from 82.5% (range, 70-100%) to 39% (range, 26-54%) of the normal side. Two tibiae had no longitudinal growth after lengthening. The average postoperative growth rate of the femur decreased from 83% (range, 70-90%) to 61% (range, 26-125%). In one patient there was an increase in the rate of growth of the femur. These findings suggest that limb lengthening in skeletally immature children with total fibular hemimelia results in severe growth retardation of the tibia after lengthening. The subsequent growth of the tibia after lengthening in patients with total fibular hemimelia is unpredictable.