Bilateral congenital absence of the fibula

Outcome of eight-plate hemiepiphysiodesis on genu valgum and height correction in bilateral fibular hemimelia

Fibular hemimelia is the most common lower extremity congenital longitudinal deficiency leading to cosmetic deformity, pain, and gait disturbance. Eight-plate hemiepiphysiodesis has proven to be successful in correcting angular deformity of the knee; it is an easy surgical technique and yields a more rapid rate of correction. The aim of this study was to determine the effectiveness of eight-plate hemiepiphysiodesis in bilateral genu valgum resulting from fibular hemimelia and overall height improvement in two girls and four boys with a mean age of 22 months who were followed up for a period of 18 months. The variables studied were arm span, the total height ratio, intermalleolar distance, tibiofemoral angle, and activity. All the parameters improved significantly. The mean improvement in the valgus was 7.41°. The mean intermalleolar distance reduced by 19.5 cm, and all patients achieved a significant improvement in lower limb function. Although there was significant improvement in total height, it still lagged behind arm span at the time of final follow-up. The results of eight-plate hemiepiphysiodesis were found to be satisfactory. We conclude that it is a reasonable treatment option for young patients with an adequate growth potential.

Combined fibular and tarsal agenesis in a case of lower extremity hemimelia

Fibular hemimelia is a congenital disorder characterized by partial or total absence of the fibula. The appearance of the affected limb can range from barely detectable to severe deformity. An affected extremity typically displays a valgus foot and ankle, shortening of the leg, anterior bowing of the tibia and knee, tarsal coalition, as well as radiographic absence of 1 to several lateral rays (1, 2). We encountered an adult patient who displayed fibular agenesis in combination with absence of the ipsilateral talus and cuboid. Because of the rarity of this deformity, we believed that it was important to describe her case despite the fact that, after evaluation and discussion of treatment options, the decision was made to continue to accommodate the deformity with an orthosis.