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Limb Lengthening and Deformity Correction by the Ilizarov Technique in Type III Fibular Hemimelia: An Alternative to Amputation

  • Clinical Research
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Background

Fibular hemimelia is partial or total aplasia of the fibula; it represents the most frequent congenital defect of the long bones. It usually is associated with other anomalies of the tibia, femur, and foot.

Questions/purposes

We reviewed 32 patients with Type III fibular hemimelia treated by successive lower limb lengthening and deformity correction using the Ilizarov method. We had three aims; first, to analyze complications, including the need for reoperation. The second was to assess knee and ankle function, specifically addressing knee ROM and stability and function of the foot and ankle. The third was assessment of overall patient satisfaction.

Patients and Methods

Thirty-two patients underwent 56 tibia lengthenings and 14 ipsilateral femoral lengthenings. Their mean age and mean functional leg-length discrepancy at initial treatment were 6.7 years and 6.2 cm, respectively. Activity level, pain, patient satisfaction with function, pain, and cosmesis, complications, and residual length discrepancy were assessed at the end of treatment.

Results

The mean number of surgeries was six per case. The healing index was 44.9 days/cm. Although complications were observed during 60 lengthenings (82%), the highly versatile system overcame most of them. Nearly equal limb length and a plantigrade foot were achieved by 16 patients. For two patients, a Syme’s amputation was performed. The outcome was considered satisfactory in 17 patients (53%) and relatively good in eight patients (25%).

Conclusions

The Ilizarov technique has satisfactory results for treatment of Type III congenital fibular hemimelia and can be considered a good alternative to amputation.

Level of Evidence

Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.

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References

  1. Achterman C, Kalamchi A. Congenital deficiency of the fibula. J Bone Joint Surg Br. 1979;61:133–137.

    PubMed  Google Scholar 

  2. Basbozkurt M, Yildiz C, Kömürcü M, Demiralp B, Kürklü M, Atesalp AS. [Management of fibular hemimelia with the Ilizarov circular external fixator] [in Turkish]. Acta Orthop Traumatol Turc. 2005;39:46–53.

    PubMed  Google Scholar 

  3. Birch JG, Walsh SJ, Small JM, Morton A, Koch KD, Smith C, Cummings D, Buchanan R. Syme amputation for the treatment of fibular deficiency: an evaluation of long-term physical and psychological functional status. J Bone Joint Surg Am. 1999;81:1511–1518.

    PubMed  CAS  Google Scholar 

  4. Boyd HB. Amputation of the foot with calcaneotibial arthrodesis. J Bone Joint Surg Am. 1939;21:997–1000.

    Google Scholar 

  5. Bradish CF. [Management of fibular hemimelia][in German]. Orthopade. 1999;28:1034–1044.

    PubMed  CAS  Google Scholar 

  6. Catagni MA, Bolano L, Cattaneo R. Management of fibular hemimelia using the Ilizarov method. Orthop Clin North Am. 1991;22:715–722.

    PubMed  CAS  Google Scholar 

  7. Cheng JC, Cheung KW, Ng BK. Severe progressive deformities after limb lengthening in type-II fibular hemimelia. J Bone Joint Surg Br. 1998;80:772–776.

    Article  PubMed  CAS  Google Scholar 

  8. Hany H. Management of fibular hemimelia by the Ilizarov technique. Egyptian Orthop J. 1999;34:41–45.

    Google Scholar 

  9. Herring JA. Symes amputation for fibular hemimelia: a second look in the Ilizarov era. Instr Course Lect. 1992;41:435–436.

    PubMed  CAS  Google Scholar 

  10. Herring JA, Barnhill B, Gaffney C. Syme amputation: an evaluation of the physical and psychological function in young patients. J Bone Joint Surg Am. 1986;68:573–578.

    PubMed  CAS  Google Scholar 

  11. Ilizarov GA. The tension-stress effect of the genesis and growth of tissues: Part 1. The influence of stability of fixation and soft-tissue preservation. Clin Orthop Relat Res. 1989;238:249–281.

    PubMed  Google Scholar 

  12. Jawish R, Carlioz H. Conservation of the foot in the treatment of longitudinal external ectromelia. Rev Chir Orthop Reparatrice Appar Mot. 1991;77:115–120.

    PubMed  CAS  Google Scholar 

  13. McCarthy JJ, Glancy GL, Chang FM, Eilert RE. Fibular hemimelia: comparison of outcome measurements after amputation and lengthening. J Bone Joint Surg Am. 2000;82:1732–1735.

    PubMed  Google Scholar 

  14. Miller LS, Bell DF. Management of congenital fibular deficiency by Ilizarov technique. J Pediatr Orthop. 1992;12:651–657.

    PubMed  CAS  Google Scholar 

  15. Naudie D, Hamdy RC, Fassier F, Morin B, Duhaime M. Management of fibular hemimelia: amputation or limb lengthening. J Bone Joint Surg Br. 1997;79:58–65.

    Article  PubMed  CAS  Google Scholar 

  16. Patel M, Paley D, Herzenberg JE. Limb-lengthening versus amputation for fibular hemimelia. J Bone Joint Surg Am. 2002;84:317–319.

    PubMed  Google Scholar 

  17. Sharma M, MacKenzie WG, Bowen JR. Severe tibial growth retardation in total fibular hemimelia after limb lengthening. J Pediatr Orthop. 1996;16:438–444.

    PubMed  CAS  Google Scholar 

  18. Stanitski DF, Stanitski CL. Fibular hemimelia: a new classification system. J Pediatr Orthop. 2003;23:30–34.

    Article  PubMed  Google Scholar 

  19. Tomás-Gil J, Valverde Belda D, Chismol-Abad J, Valverde-Mordt C. Complete fibular hemimelia: a long-term review of four cases. Acta Orthop Belg. 2002;68:265–271.

    PubMed  Google Scholar 

  20. Walker JL, Knapp D, Minter C, Boakes JL, Salazar JC, Sanders JO, Lubicky JP, Drvaric DM, Davids JR. Adult outcomes following amputation or lengthening for fibular deficiency. J Bone Joint Surg Am. 2009;91:797–804.

    Article  PubMed  Google Scholar 

  21. Zarzycki D, Jasiewicz B, Kacki W, Koniarski A, Kasprzyk M, Zarzycka M, Tesiorowski M. Limb lengthening in fibular hemimelia type II: can it be an alternative to amputation? J Pediatr Orthop B. 2006;15:147–153.

    PubMed  Google Scholar 

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Authors and Affiliations

  1. Orthopedic Department, “Alessandro Manzoni Hospital”, Lecco, Italy

    Maurizio A. Catagni MD, Luigi Lovisetti MD & Francesco Guerreschi MD

  2. Faculty of Medicine, Zagazig University, Zagazig, Egypt

    Makram Radwan MD

  3. Department of Orthopedic Surgery, Faculty of Medicine, Mansoura University, Elgomhoria Street, Mansoura, 35516, Dakahlia, Egypt

    Nabil A. Elmoghazy MD

Authors
  1. Maurizio A. Catagni MD
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  2. Makram Radwan MD
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  3. Luigi Lovisetti MD
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  4. Francesco Guerreschi MD
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  5. Nabil A. Elmoghazy MD
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Corresponding author

Correspondence to Nabil A. Elmoghazy MD.

Additional information

Each author certifies that he or she has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.

This work was performed at Lecco General Hospital, Lecco, Italy.

Each author certifies that his or her institution approved the human protocol for this investigation that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.

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Catagni, M.A., Radwan, M., Lovisetti, L. et al. Limb Lengthening and Deformity Correction by the Ilizarov Technique in Type III Fibular Hemimelia: An Alternative to Amputation. Clin Orthop Relat Res 469, 1175–1180 (2011). https://doi.org/10.1007/s11999-010-1635-7

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  • DOI: https://doi.org/10.1007/s11999-010-1635-7

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