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Figure B
22%
480/2160
Figure C
8%
180/2160
Figure D
7%
160/2160
Figure E
21%
451/2160
Figures D & E
40%
871/2160
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This patient has a congenital fibular deficiency (fibular hemimelia) which is associated with tarsal coalition and ball and socket ankle joint. Fibular hemimelia is the most common congenital long bone deficiency and usually involves the entire limb. The classic appearance is a short limb and skin dimpling over the anteromedial tibial bowing. Fibular hemimelia is associated with ankle instability secondary to a ball and socket ankle, equinovalgus foot deformity, tarsal coalition (50%), absent lateral rays, femoral abnormalities (PFFD, coxa vara), anterior and posterior cruciate ligament deficiency, and lateral femoral condyle hypoplasia. Birch et al. reviewed 122 patient with congenital fibular deficiency to form a new classification system for these patients. They assessed the impact of limb-length inequality, foot deformity, bilateral extremity involvement, and extent of fibular preservation on the treatment of the limb deficiency. Their new classification system is based on the clinical status of the foot and the magnitude of limb shortening as a percentage of the contralateral limb on radiographs. Hamdy et al. reviewed congenital fibular deficiency. They note that the etiology of CFD remains unclear. Treatment goals are to achieve normal weight bearing, a functional plantigrade foot, and equal limb length. Treatment options include orthosis or epiphysiodesis, Syme or Boyd amputation and prosthetic rehabilitation, limb lengthening procedures, and foot and ankle reconstruction. Figure A demonstrates standing radiographs of a patient with congenital fibular deficiency resulting in limb length discrepancy. Figure B is a standing radiograph of a patient with scoliosis Figure C is a radiograph of the hand showing pre-axial polydactyly Figure D is a CT demonstration a tarsal coalition Figure E is a radiograph of a patient with a ball and socket ankle Incorrect answers Answer 1: Scoliosis has not been associated with congenital fibular deficiency Answer 2: Polydactyly has not been associated with congenital fibular deficiency
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