Also known as congenital absence of the fibula, congenital fibular deficiency, paraxial fibular hemimelia and aplasia/hypoplasia of the fibula, fibular hemimelia . Fibular hemimelia. Disease definition. Fibular hemimelia is a congenital longitudinal limb deficiency characterized by complete or partial absence of the fibula. consists of shortening or entire absence of the fibula; previously known as fibular hemimelia; the most common congenital long bone deficiency.

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If femoral lengthening is considered, it is factored into the surgical life plan discussed previously. The distal tibial physis is at the ankle joint level. Find the separation between the gastrocnemius muscle and the peroneal muscles. Both patients and parents completed psychosocial, quality of life QoL and satisfaction surveys.

If lengthening is to be performed at the same surgery, an arthrogram is carried out at the knee joint. If a hypoplastic fibula remnant is present it can be shifted distally or the tibia shortened relative to the fibula in order to relatively lengthen the fibula to the tibia and restore the buttress effect of the lateral malleolus. A more subtle deformity of the ankle is one that is often not visible on the x-ray: The less dysplastic the talus is to begin with, the greater the potential range of ankle motion; the more dysplastic the talar anatomy, the greater the limitation of ankle motion.

The axial wires are backed out until the osteotomy is completed. Dal Monte A, Donzelli O. Diagnostic methods Diagnosis is based on clinical examination and X-rays. Most midfoot deformities are most commonly related to coalition between the cuboid and calcaneus. Insert a guide wire in the frontal plane parallel to the valgus angle of the foot when it is dorsiflexed parallel to plantar aspect of hemimela foot Fig.


Example of reconstructive life plan A 6-month-old boy presents with Paley type 3c FH. In order to become proficient with the various variations of the SUPERankle procedure, for the different Paley types, one needs to perform this operation several times a year. After inserting two guide wires 3 frontal plane; 4 sagittal plane inserted perpendicular to the proximal tibia at the level of the overlap, a second osteotomy is performed to resect the bone fihular.

Absence or weakness of the peroneus longus may lead to overpull of the tibialis anterior and elevation of the first metatarsal with compensatory flexion of the first metatarsophalangeal joint dorsal bunion. Hemimflia the struts are in place the remainder of the fixation is added.

If the fibula is absent or deficient, then the ankle will sublux or hemimellia into valgus. Treatment depends on how an individual child is affected. Socioeconomic factors may limit such second opinion options. The subtalar joint pathology ranges from a normal subtalar joint to a subtalar joint with subtalar coalition.

Surgical reconstruction for fibular hemimelia

The Paley classification of FH describes of four types of FH, with type 3 subdivided into three subtypes, as shown in the following list. Mount external fixator to tibia and foot. In many cases the ankle of type 1 cases appears completely normal, and the fibula is only jemimelia shorter at its upper end compared to the opposite side.

Skip to content Content Area Fibular hemimelia is a birth defect where part or all of the fibular bone is missing, as well as associated limb length discrepancy, foot deformities, and knee nemimelia. When kids have small differences in leg length, the care team might suggest a surgery called epiphysiodesis ep-i-fiz-ee-uh-DEE-sis. This does not prove, however, that the best treatment for severe cases of FH is amputation with prosthetic fitting.

Fibular Hemimelia | Paley Orthopedic & Spine Institute

This combination of slower tibia and femur growth leads to a limb length discrepancy. Achterman C, Kalamchi A. Furthermore, many patients developed a supination midfoot fbular with a dorsal bunion due to overpull of the tibialis anterior from a weak peroneus longus tendon.


It involves shortening and realignment of the distal tibia relative to the fibula. Knee ligament deficiencies and knee valgus deformity as well as associated femoral hypoplasia, dysplasia and partial aplasia are common.

This is a testimony to the excellence of modern prosthetics and nothing more.

Springer, Berlin New York, pp 31— None of the ankles had residual instability. An analysis of the unsatisfactory results reported in different series in the literature [ 36 — 3842 ] makes it clear that the overriding hemkmelia associated with poor results hemomelia recurrent or residual foot and tibial deformities—and not the inability to obtain equalization of limb length.

This author prefers to complete the last lengthening before the patient is in high school, for social reasons, if possible.

The new bone formation is excellent. Be careful not to damage the superficial peroneal nerve. The foot is in fixed equino-valgus.

Fibular hemimelia

Fix the tibia with a small medial tibial locking T plate Fig. Sometimes, there isn’t a lot of difference in leg length. These guide wires are inserted at the angle of the plane of the osteotomy. Nevertheless, if an amputation could be avoided and the foot and ankle and leg reconstructed to nearly normal function comparable to that afforded by a below-the-knee prosthetic, most parents and most individuals will choose to have the reconstruction.

All but three limbs had regained their preoperative range of ankle motion. Although genetic abnormalities are linked to FH, the condition is not heritable. The fibular anlage is located like the string of a bow in a straight line opposite the concavity of this deformity.