Leg lengthening and deformity correction in fibular hemimelia using ring external fixator

Hossam Mohammed Ghaly; Abdel Hafez Abdel Hazfez Megahed; Emad Abdel Fattah Elmehy; Mostafa Hussein Hegazy

doi:10.53730/ijhs.v6nS4.10504

Authors

Hossam Mohammed Ghaly Orthopedic Surgery Department, Faculty of Medicine, Tanta University, Tanta, Egypt
Abdel Hafez Abdel Hazfez Megahed Orthopedic Surgery Department, Faculty of Medicine, Tanta University, Tanta, Egypt
Emad Abdel Fattah Elmehy Orthopedic Surgery Department, Faculty of Medicine, Tanta University, Tanta, Egypt
Mostafa Hussein Hegazy Orthopedic Surgery Department, Faculty of Medicine, Tanta University, Tanta, Egypt

Keywords:

leg lengthening, deformity correction, fibular hemimelia, ring external fixator

Abstract

Background: The treatment of fibular hemimelia aims to achieve a functional limb nearly equal in length to the normal limb at maturity, with a plantigrade, stable and flexible foot. The aim of this work was to evaluate the functional results of reconstructive lengthening and deformity correction in fibular hemimelia using the ring external fixator. Methods: This observational study was carried out on 41 patients with fibular hemimelia. The cases either prospectively gathered (sixteen cases, 39 %) to start their management plan or retrospectively collected (twenty-five cases, 61 %) and followed up. Foot reconstruction surgery was done in 22 cases while lengthening surgery applied all cases. All patients were subjected to: history taking, clinical examination (local (lower limb), foot and knee), general examination and imaging. Results: regarding overall results, at the end of follow-up with an average period of 2 years, 4 patients had excellent results (9.76%), 21 patients (51.2%) had good results, 12 patients (29.28%) had fair results and 4 patients (9.76%) had poor result. Regarding subjective functional assessment, out of 41 patients, 20 of them (48.8%) were from 75 to 100% subjectively satisfied, 11 patients (26.8%) from 50 to 74% and 10 patients (24.4%) from 0 to 49% satisfied.

Downloads

Download data is not yet available.

References

Barawi OAR, Amen ZJ. Management of fibular hemimelia (Congenital absence of fibula) using ilizarov method in sulaimani. Eur Sci J. 2015;11:1-6.

Cheng JC, Cheung KW, Ng BK. Severe progressive deformities after limb lengthening in type-II fibular hemimelia. J Bone Joint Surg Br. 1998;80:772-6.

Epps CH, Jr., Schneider PL. Treatment of hemimelias of the lower extremity. Long-term results. J Bone Joint Surg Am. 1989;71:273-7.

Coventry MB, Johnson EW, Jr. Congenital absence of the fibula. J Bone Joint Surg Am. 1952;34 a:941-55.

Barham G, Clarke NMP. Genetic regulation of embryological limb development with relation to congenital limb deformity in humans. J Child Orthop. 2008;2:1-9.

Achterman C, Kalamchi A. Congenital deficiency of the fibula. J Bone Joint Surg Br. 1979;61-b:133-7.

Birch JG, Lincoln TL, Mack PW, Birch CM. Congenital fibular deficiency: a review of thirty years' experience at one institution and a proposed classification system based on clinical deformity. J Bone Joint Surg Am. 2011;93:1144-51.

Birch JG, Paley D, Herzenberg JE, Morton A, Ward S, Riddle R, et al. Amputation Versus Staged Reconstruction for Severe Fibular Hemimelia: Assessment of Psychosocial and Quality-of-Life Status and Physical Functioning in Childhood. JB JS Open Access. 2019;4:53-6.

Fuller CB, Shannon CE, Paley D. Lengthening Reconstruction Surgery for Fibular Hemimelia: A Review. Children (Basel). 2021;8:467-9.

Letts M, Vincent N. Congenital longitudinal deficiency of the fibula (fibular hemimelia). Parental refusal of amputation. Clin Orthop Relat Res. 1993:160-6.

Paley D, Bhave A, Herzenberg JE, Bowen JR. Multiplier method for predicting limb-length discrepancy. J Bone Joint Surg Am. 2000;82:1432-46.

Günal I, Turgut A, Köse N. Structural properties of the fibular band in congenital total absence of the fibula. Arch Orthop Trauma Surg. 1999;119:217-9.

Zarzycki D, Jasiewicz B, Kacki W, Koniarski A, Kasprzyk M, Zarzycka M, et al. Limb lengthening in fibular hemimelia type II: can it be an alternative to amputation? J Pediatr Orthop. 2006;15:147-53.

Kirienko A, Portinaro N, editors. Correction of the tibia and equino-valgus foot deformity in type II fibular hemimelia with ilizarov method. Orthopaedic Proceedings; 2003: The British Editorial Society of Bone & Joint Surgery.

Choi IH, Kumar SJ, Bowen JR. Amputation or limb-lengthening for partial or total absence of the fibula. J Bone Joint Surg Am. 1990;72:1391-9.

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.

Başbozkurt M, Yildiz C, Kömürcü M, Demiralp B, Kürklü M, Ateşalp AS. [Management of fibular hemimelia with the Ilizarov circular external fixator]. Acta Orthop Traumatol Turc. 2005;39:46-53.

Griffith SI, McCarthy JJ, Davidson RS. Comparison of the complication rates between first and second (repeated) lengthening in the same limb segment. J Pediatr Orthop. 2006;26:534-6.

Fuller CB, Shannon CE, Paley D. Lengthening Reconstruction Surgery for Fibular Hemimelia: A Review. Children. 2021;8:467-9.

Antoci V, Ono CM, Antoci V, Jr., Raney EM. Bone lengthening in children: how to predict the complications rate and complexity? J Pediatr Orthop. 2006;26:634-40.

Paley D. Problems, obstacles, and complications of limb lengthening by the Ilizarov technique. Clin Orthop Relat Res. 1990:81-104.

Nyandra, M., Kartiko, B.H., Susanto, P.C., Supriyati, A., Suryasa, W. (2018). Education and training improve quality of life and decrease depression score in elderly population. Eurasian Journal of Analytical Chemistry, 13(2), 371-377.

Nyandra, M., Suryasa, W. (2018). Holistic approach to help sexual dysfunction. Eurasian Journal of Analytical Chemistry, 13(3), pp. 207–212.