Type III longitudinal deficiency of the tibia and outcome of reconstructive surgery in a female patient

Radivoj Brdar,Ivana Petronic,Dragana Cirovic,Dusan Abramovic,Dejan Nikolic,Marija Lukac,Tatjana Knezevic

doi:10.3390/medicina46020018

Abstract

Type III longitudinal deficiency of tibia according to Kalamchi and Dawe denotes the presence of distal hypoplasia of the tibia with diastasis. We report a case of type III longitudinal deficiency of the tibia in a female patient who later underwent reconstructive surgery. The first reconstruction of the leg was done when child turned 4 months of age. Surgical procedures included foot reconstruction and ankle stabilization with twice lengthening by the Ilizarov method (14 cm in total). During the follow-up, both the tibia and fibula of the affected leg showed the same lengthening and regression due to preserved distal growth zone cartilage. After surgical correction, the acetabulum was satisfactorily configured with an acetabular angle of 23 degrees. Explanation for surgical success was that osteotomy and distraction were done in the proximal part of the crural region where the growth potential was better. The tibia remained lean and hypoplastic while the fibula was incrassated. The function in the area of the knee joint was preserved, while the distal part of the leg served as good stand on. When the child was 18 years old, on check-up, the acetabular angle was 23 degrees while the Wiberg angle was 24 degrees.

Highlights

Type III longitudinal deficiency of the tibia (LDT) is a rare pathological condition with an incidence of one per one million newborns [1, 2]
Earlier proposed classifications of LDT by Jones et al and Kalamchi and Dawe are based on radiographicy findings [6, 7]
Jones et al stress out that type III LDT presents with an overall short tibia, proximal and distal epiphysis with relatively normal fibula in shape and development [6] while Kalamchi and Dawe classified type III LDT as distal hypoplasia of the tibia with diastasis [7]

Summary

Introduction

Type III longitudinal deficiency of the tibia (LDT) is a rare pathological condition with an incidence of one per one million newborns [1, 2]. It is often associated with other anomalies [3,4,5]. Since our patient underwent the first examination before newly proposed classification categories, we diagnosed type III LDT according to the Kalamchi and Dawe classification. Radiographic findings revealed the presence of the tibia with poorly developed distal part and significant diastasis of the tibia and fibula distally. Reexamination of the patient at the age of 18 years showed that reconstructive surgery yielded good results and was considered effective mainly because functional walking status was maximally preserved and improved (Fig. 3)

Discussion

Conclusion

Trečiojo tipo išilginio blauzdikaulio defekto rekonstrukcinė operacija