Strategies in Trauma and Limb Reconstruction

Register      Login

VOLUME 7 , ISSUE 1 ( April, 2012 ) > List of Articles

Original Article

Ankle reconstruction in type II fibular hemimelia

Hazem Mossad El-Tayeby, Amin Abdel Razek Youssef Ahmed

Keywords : Fibular hemimelia, Ankle reconstruction

Citation Information : El-Tayeby HM, Ahmed AA. Ankle reconstruction in type II fibular hemimelia. 2012; 7 (1):23-26.

DOI: 10.1007/s11751-012-0129-4

License: CC BY-NC-SA 4.0

Published Online: 30-04-2012

Copyright Statement:  Copyright © 2012; Jaypee Brothers Medical Publishers (P) Ltd.


Abstract

Ankle reconstruction prior to limb lengthening for was performed in 13 patients with fibular hemimelia with complete radiological absence of the fibula (type II). There were different degrees of absence of metatarsal rays. The hindfoot deformity was a heel valgus in 12 patients and equinovarus in 1 patient. The patients’ ages ranged from 9 to 26 months. Excision of the fibular anlage was performed with lateral subtalar and ankle soft tissue releases to restore the ankle and subtalar joint relationships. In all cases, the fibular anlage ended distally in a cartilaginous lateral malleolar remnant that was fused to the talus in two patients. This fibular remnant was advanced distally and fixed to the tibia with 2 Kirschner wires to recreate an ankle mortise. The period of follow-up ranged from 12 to 38 months. All patients had a stable ankle without tendency to valgus deformity or subluxation. The ankle range of movement was a mean of 27.3° plantarflexion (25–30) and 18° dorsiflexion (15–20). Reconstruction of the ankle in type II fibular hemimelia using advancement of the cartilaginous lateral malleolar remnant has produced encouraging results in the short-term but longer follow-up is needed.


PDF Share
  1. Goh JC, Mech AMI, Lee EH (1992) Biomechanical study on the load-bearing characteristics of the fibula and the effects of the fibular resection. Clin Orthop 279:223-228
  2. Lee EH, Goh JC, Helm R (1990) Donor site morbidity following resection of the fibula. J Bone Joint Surg (Br) 72-B:129-131
  3. Shogi H, Koshino T, Marcove RC (1970) Subperiosteal resection of the distal portion of the fibula for aneurysmal bone cyst. J Bone Joint Surg (Am) 52-A:1472-1476
  4. Naudie D, Hamdy RC, Fassier F, Morin B, Duhaime M (1997) Management of fibular hemimelia: amputation or limb lengthening. J Bone Joint Surg (Br) 79-B:58-65
  5. Achterman C, Kalamchi A (1979) Congenital deficiency of the fibula. J Bone Joint Surg (Br) 61-B:133-137
  6. Choi IH, Lipton GE, Macckenzie W, Bowen R, Kumar J (2000) Wedge-shaped distal tibial epiphysis in the pathogenesis of equinovalgus deformity of the foot and ankle in tibial lengthening for fibular hemimelia. J Pediatr Orthop 20:428-436
  7. Catagni MA, Bolano L, Cattaneo R (1991) Management of fibular hemimelia using the Ilizarov method. Orthop Clin North Am 22:715-722
  8. Corell J (1997) Management of fibular hemimelia. J Bone Joint Surg (Br) 79-B:1040-1041
  9. Gibbons PJ, Bradish CF (1996) Fibular hemimelia: a preliminary report on management of the severe abnormality. J Pediatr Orthop B 5:20-26
  10. Miller LS, Bell DF (1992) Management of congenital fibular deficiency by Ilizarov technique. J Pediatr Orthop 12:651-657
  11. Exner GU (2003) Bending osteotomy through the distal tibial physis in fibular hemimelia for stable reduction of the hindfoot. J Pediatr Orthop B 12:27-32
  12. Rajacic N, Dashti H (1996) Reconstruction of the lateral malleolus using a reverse-flow vascularized fibular head: a case report. Microsurgery 17:158-161
  13. Thomas IH, Williams PF (1987) The GRUCA operation for congenital absence of the fibula. J Bone Joint Surg (Br) 69-B:587-592
  14. Serafin J (1967) A new operation for congenital absence of the fibula. Preliminary report. J Bone Joint Surg Br 49B:59-65
  15. Weber M, Siebert CH, Goost H, Johannisson R, Wirtz D (2002) Malleolus externus plasty for joint reconstruction in fibular aplasia: preliminary report of a new technique. J Pediatr Orthop B 11:265-273
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.