Also known as congenital absence of the fibula, congenital fibular deficiency, paraxial fibular hemimelia and aplasia/hypoplasia of the fibula, fibular hemimelia . Fibular hemimelia. Disease definition. Fibular hemimelia is a congenital longitudinal limb deficiency characterized by complete or partial absence of the fibula. consists of shortening or entire absence of the fibula; previously known as fibular hemimelia; the most common congenital long bone deficiency.

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Paley presented unpublished results presented at AAOSAnaheim, California similar results to those of these last three studies. Others have a large limb length difference and unstable joints. Hemimdlia Platybasia Craniodiaphyseal dysplasia Dolichocephaly Greig cephalopolysyndactyly syndrome Plagiocephaly Saddle nose.

A second incision is made antero-laterally overtop the distal tibio-fibular syndesmosis. The surgery can add about 8 inches 20 centimeters to the shorter leg.

Doctors do different surgeries depending on a child’s situation. The advent of internal lengthening methods makes femoral lengthening as a separate procedure much easier. Management of congenital fibular deficiency by Ilizarov technique. The material is in no hemijelia intended to replace professional medical care by a qualified specialist and should not be used as a basis for diagnosis or treatment.

Most of the cases presented by Sharma et al. Apply proximal and distal rings with half pins and hemimeliw b.

Fibular Deficiency (anteromedial bowing)

In most cases this is a hemimelka metatarsal fusion of first and second metatarsal associated with syndactaly of the first and second toes. Limb length discrepancy Fibuular and ankle deformities Knee deformity For more information on the etiology and treatment of fibular hemimelia, please see our Fibular Hemimelia FAQ.

Most feet have a ball and socket ankle joint with a fibula that is relatively short compared to the tibia at the level of the ankle joint.

There is a leg length discrepancy. Paley Institute, 45th St. If the distal tibiofibular joint is not stable, insert a syndesmotic double washer compression suture such as a TightRope Arthrex Inc. Talo-navicular joint coalition can also be present.


When it is missing, this stabilizing effect is absent. Make the first osteotomy along the proximal frontal plane wire perpendicular to the proximal tibial diaphysis Figs. Separate the muscles from either side of it and then cut the septum all the way down to where it passes over the deep peroneal nerve Fig.

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Dror Paley Paley Institute, 45th St. Use the elevator or scissors to release part of the distal interosseous membrane between the tibia and fibula. Toe and metatarsal surgery Many patients with FH are missing one or more toes. A new classification system”. All of the adults in the series were gainfully employed, including the one who required an ankle fusion.

All but three limbs had regained their preoperative range of ankle motion. A child might have one leg that is very much shorter than the other or a foot problem that can’t be fixed. Equal leg lengths with a plantigrade foot were achieved in each of these patients. Dissect its borders free anteriorly and posteriorly working from distal to proximal.

If there is an abductus foot deformity this is almost always related to an associated calcaneocuboid coalition tethering the foot into abductus. The most commonly used classification is that of Achterman and Kalamchi [ 11 ], which describes the amount of fibular deficiency.

At the time of evaluation, the average patient age was 9 range 5—15 years. The next two crossed wires enter postero-lateral and posteromedial to this first wire to exit antero-medial and antero-lateral, respectively. Insert supramalleolar tibial guide wires in the frontal and sagittal planes parallel to the plantar aspect of the foot as distal as possible without crossing the distal tibial physis Fig. Arthrogryposis Hemimeliz syndrome Rapadilino syndrome.

Orphanet: Fibular hemimelia

If, however, this coalition is joined in an abnormal fashion, so that it is tilted outwards valgus or inwards varus then it leads to additional deformity of the foot and ankle. New prosthetics mean kids who have had an amputation can run, climb, and jump like other kids. The tibia may be subluxed anteriorly relative to the femur. The main difference between the groups was that families of children treated by amputation had lower economic and educational levels and were more ethnically diverse that those of the limb reconstruction group.


Furthermore, children with FH have associated foot deformities that result in a shorter foot which also contributes to the limb length discrepancy. Insert a guide wire in the frontal plane parallel to the valgus angle of the foot when it is dorsiflexed parallel to plantar aspect of the foot Fig.

All patients and parents reported satisfaction with treatment method selected and would select the same treatment method again. While the foot can be placed plantigrade, the ankle naturally rolls outwards, and the patient stands and walks in valgus. Add a walking ring and secure axial wires to the frame. The new bone formation is excellent.

Fibular Hemimelia (for Parents)

Tarsal tunnel decompression in leg lengthening and deformity correction of the foot and ankle. If the deformity is from the tibia, and if tibial lengthening is carried fibulxr, then the deformity can be corrected through the lengthening osteotomy of the proximal tibia.

Treatment depends on how an individual child is affected. The ankle joint, which is often a ball and socket type, cannot compensate for a valgus knee since it usually has valgus instability dynamic valgus.

Displace the osteotomy and disengage the bone fragments. Others need surgery to stand and walk. Fibular hemimelia is not heemimelia condition where all of the cases have the same amount of deformity or deficiency or limb length discrepancy. Insert two guide wires parallel to the plantar aspect of the foot in the frontal 1 and sagittal 2 planes. For all other comments, please send your remarks via contact us.