Limb reconstruction for tibial hemimelia

Abstract

Background Tibial hemimelia is a rare congenital anomaly and is usually accompanied by congenital abnormalities in other parts in the body. The treatment is always difficult and challenging. Amputation was the preferred treatment option; however, a reconstructive surgery is sometimes used in the cases of amputation refusal. Aim The purpose of this study was to determine the results of limb reconstruction in eight children with Jones type II tibial hemimelia by fibular tibialization, ankle fusion, and lower limb lengthening using Ilizarov external fixator. Patients and methods A retrospective study was conducted on eight children presented with Jones type II tibial hemimelia, who were treated by fibular tibialization, ankle fusion, and lower limb lengthening using Ilizarov external fixator. The study had been done at Zagazig University hospitals between March 2007 and October 2014. The mean age of the patients was 3 years (range, 2–5 years). There were five girls and three boys. All had unilateral affection; right side was affected in five children and left in three. All cases had leg-length discrepancy that ranged from 5 to 7 cm, and all feet had equinovarus deformity. Results The mean follow-up period was 3 years (range, 2–5 years). In all the cases, the transferred fibular shaft to the distal end of the tibial remnant was united within 2–3 months. Consolidation of the bone at the distraction site was obtained with a gained length of 5–6.5 cm in all patients. The external fixator was applied for an average time of 150 days, and the healing index was 29 days/cm. The mean maximum knee flexion was 100° (range 90°–110°], and instability of less than 5° in varus valgus plane was seen in two cases. The ankle and foot deformity improved by foot repositioning and arthrodesis, achieving a plantigrade foot. The mean calcaneofibular angle was 100° (range, 90°–110°). The parents of all the patients showed full satisfaction at the latest follow-up. Conclusion The results of limb reconstruction of the Jones type II tibial hemimelia by fibular tibialization, ankle fusion, and lower limb lengthening using Ilizarov external fixator were acceptable. The limb was saved and reconstructed.