Fibular hemimelia

Fibular hemimelia

In fibular hemimelia there is a congenital failure of formation of the lateral ‘column’ of the lower leg ( Figure 44.26 and Table 44.9 ).

TABLE 44.9 Classical radiographic features of /f_i bular hemimelia. Foot and ankle Absent lateral rays; tarsal coalition; ball

and-socket ankle joint Lower leg Absent or de /f_i cient /f_i bula; short, bowed tibia Knee Absent tibial spine (no cruciate ligament); de /f_i cient lateral femoral condyle Femur Relative hypoplasia Limb length and Short; external rotation with/without alignment valgus

Management is tailored to the severity of the deficiency . Treatment options range from a shoe raise, through multiple episodes of limb equalisation surgery to amputation for the worst cases. An early prediction of the leg length discrepancy at maturity allows a realistic treatment plan to be devised for the patient, which should include consideration of a contra- lateral epiphysiodesis.

Figure 44.26 Anteroposterior (a) and lateral (b) radiographs of two lower limbs showing some of the features of a /f_i bular hemimelia: absent /f_i fth ray in the foot, absent /f_i bula and deformed tibia.

Fibular hemimelia

In fibular hemimelia there is a congenital failure of formation of the lateral ‘column’ of the lower leg ( Figure 44.26 and Table 44.9 ).

TABLE 44.9 Classical radiographic features of /f_i bular hemimelia. Foot and ankle Absent lateral rays; tarsal coalition; ball

and-socket ankle joint Lower leg Absent or de /f_i cient /f_i bula; short, bowed tibia Knee Absent tibial spine (no cruciate ligament); de /f_i cient lateral femoral condyle Femur Relative hypoplasia Limb length and Short; external rotation with/without alignment valgus

Management is tailored to the severity of the deficiency . Treatment options range from a shoe raise, through multiple episodes of limb equalisation surgery to amputation for the worst cases. An early prediction of the leg length discrepancy at maturity allows a realistic treatment plan to be devised for the patient, which should include consideration of a contra- lateral epiphysiodesis.

Figure 44.26 Anteroposterior (a) and lateral (b) radiographs of two lower limbs showing some of the features of a /f_i bular hemimelia: absent /f_i fth ray in the foot, absent /f_i bula and deformed tibia.

Fibular hemimelia

In fibular hemimelia there is a congenital failure of formation of the lateral ‘column’ of the lower leg ( Figure 44.26 and Table 44.9 ).

TABLE 44.9 Classical radiographic features of /f_i bular hemimelia. Foot and ankle Absent lateral rays; tarsal coalition; ball

and-socket ankle joint Lower leg Absent or de /f_i cient /f_i bula; short, bowed tibia Knee Absent tibial spine (no cruciate ligament); de /f_i cient lateral femoral condyle Femur Relative hypoplasia Limb length and Short; external rotation with/without alignment valgus

Management is tailored to the severity of the deficiency . Treatment options range from a shoe raise, through multiple episodes of limb equalisation surgery to amputation for the worst cases. An early prediction of the leg length discrepancy at maturity allows a realistic treatment plan to be devised for the patient, which should include consideration of a contra- lateral epiphysiodesis.

Figure 44.26 Anteroposterior (a) and lateral (b) radiographs of two lower limbs showing some of the features of a /f_i bular hemimelia: absent /f_i fth ray in the foot, absent /f_i bula and deformed tibia.