Treatment traps of fibular hemimelia

Abstract

Objective To discussed the difficulties of treating FH by reviewing our experiences. Methods From June 2006 to July 2014, a total of 11 FH patients underwent tibial lengthening at our hospital, 8 patients with unilateral involvement were classified by Achterman & Kalamchi method. And the types wereⅠa (n=2), Ⅰb (n=3) andⅡ(n=3) respectively. The mean discrepancy of femur and tibia was 3.3 (1.8-5.7) and 3.4 (2.0-4.8) cm. The external devices composed of 4 parallel rings were applied for 4 early patients. And another foot ring was added for later patients with ball and socket ankle or anticipated lengthening was over 5 cm. Two patients underwent further femoral lengthening. The average follow-up period was 3.1 years. Results A desired length was achieved for all of them with an average of 5.6 cm for tibia and 5.7 cm for femur. The mean healing index was 44.7 days/cm for tibia and 61 days/cm for femur. Marked deformities were observed in 4 early patients, including progressive genu valgum & ankle valgus (n=3), valgus deformity of tibia (n=2) and recurrent genu valgum after femoral lengthening (n=1) while only genu valgum in later patients. Conclusions Such anatomic abnormalities as lateral femoral condyle hypoplasia, unstable knee and ankle joints may be overlooked while treating FH via Ilizarov technique. And we should appreciate these abnormalities to reduce the incidence of complications and boost the success rate of treatment. Key words: Fibula; Bone dieases, developmental; Bone lengthening; Treatment outcome