Staged Soft Tissue, Bony and Ilizarov Procedures for Correction of Leg and Foot Deformities in Tibial Hemimelia

Abstract

Background: The incidence of tibial hemimelia is very rare being about 1 per million in the reported literature. The deformity varies according to the type of the deficiency, the involved leg is short and the foot is held in equinovarus. In type II, partial development of the tibia eventually occurs, and a relatively functional knee joint is present, the fibula is usually normal in size, but the head is proximally dislocated. Material and methods: The material of this study included 8 patients with tibial hemimelia (Jones type II). Five were boys and 3 girls. The average age of the patients at the time of the first operation was 2.3 years (1-4 years) and the average follow up period was 31 (14-60 months). Right leg was the affected side in 3 while 5 patients had left sided tibial hemimelia. Operative steps: Soft tissue release and centralization of the fibula in the ankle was done followed by tibiofibular fusion between the proximal tibia and the fibula (side to side) at the age of 3.5-4 years in all patients and to be followed by Ilizarov distraction at the age of 5 years to pull the fibula down and then continue lengthening to equalize limb length inequality. Results: At the end of follow up period (31 months) good results were achieved in the eight cases with good range of knee movement and plantigrade foot, all patients could walk independently and without pain. All cases showed full satisfaction to the patients and their parents. Bone consolidation of the distraction site was achieved in all cases with 4.5-6.5 cm gained tibial length. There was no limb length inequality in 6 cases with residual shortening in 2 cases (2 and 2.5 cm) which did not affect the final satisfactory results. Conclusion: Early Soft tissue correction, tibiofibular fusion followed by Ilizarov distraction gave satisfactory results in cases of tibial hemimelia (Jones type II) which were difficult to be treated by the conventional methods.