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Tibia and fibula surgery12/3/2023 ![]() These are commonly referred to as postaxial deficiencies and are distinct in their pattern from preaxial deficiencies such as tibial hemimelia.įH occurs in between 1:135,000 and 1:50,000 births. It is therefore part of the same spectrum of deficiency as congenital femoral deficiency. Knee ligament deficiencies and knee valgus deformity as well as associated femoral hypoplasia, dysplasia and partial aplasia are common. The phenotype has a wide spectrum of pathology, ranging from mild to severe limb length discrepancy, ankle/foot deformities with or without subtalar coalition, midfoot coalitions and absent rays. Serial lengthening procedures combined with the SHORDT or SUPERankle reconstruction lead to limb length equalization with a plantigrade, painless, functional foot.įibular hemimelia (FH) is a congenital deficiency where part or all of the fibular bone is hypoplastic, dysplastic or aplastic associated with hypoplasia and dysplasia of the tibia and hypoplasia, dysplasia and aplasia of parts of the foot. A plantigrade-stable foot and ankle leads to an excellent functional result comparable or better than a Syme’s amputation with prosthetic fitting. The limitation of ankle motion is related to ankle dysplasia rather than surgery or lengthening. Weakening of gastro-soleus and peroneal muscles is avoided by shortening of the tibia instead of tendon lengthening. Due to the bony instead of soft tissue correction of deformity, residual or recurrent deformity is prevented. The SUPERankle uses a supramalleolar shortening-realignment osteotomy and/or subtalar osteotomies with anlage resection. In contrast, the Paley SUPERankle procedure is used when there is a fixed equinovalgus foot deformity. It involves shortening and realignment of the distal tibia relative to the fibula. The Paley SHORDT procedure is used to stabilize the ankle when there is a hypoplastic distal fibula with a dynamic valgus deformity. The purpose of this report is to introduce new classification and reconstruction methods. Published methods of surgical reconstruction have often failed due to residual or recurrent foot deformity. Previous classifications have focused on the degree of fibular deficiency rather than the type of foot deformity. ![]() Fibular hemimelia presents with foot deformity and leg length discrepancy. ![]()
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