Review Question - QID 5474

This patient has a fibular hemimelia, or more broadly speaking, postaxial hypoplasia of the lower extremity. There are a variety of associated conditions, primarily of the lower extremity. Congenital vertical talus is not one of them.

Fibular hemimelia is a rare condition but is the most common long bone deficiency. A myriad of conditions are associated, the most common of which is femoral shortening (occurring in 50%). Other associated conditions include: developmental dysplasia of the hip (DDH), clubfoot, knee valgus and flexion contracture, cruciate deficiency, knee and ankle instability, ball and socket ankle, tarsal coalition and deficiency of the lateral rays of the foot. A careful assessment of the entire lower extremity is important in such patients.

Stevens et al. review fibular hemimelia and present a treatment algorithm use on 20 patients with an emphasis on appropriately indicated and timed interventions with a goal of restoring limb length, achieving joint stability and neutral mechanical axis.

Oberc et al. evaluated 31 patients with fibular hemimelia and surgical treated 24 with a variety of procedures including Syme’s amputation, limb lengthening and limb re-alignment. The concluded that the combination of epiphysiodesis with limb lengthening, when indicated, yielded the best outcome in function and patient satisfaction.

Figure A shows a leg with an absent fibula and associated foot deformity. Illustration A shows a table of conditions associated with fibular hemimelia in the series of Oberc et al. Illustration B outlines some characteristic limb deformities. Illustrations C and D show early classification systems (Coventry and Johnson and Achterman and Kalamchi, respectively. Illustration E shows a treatment algorithm proposed by Oberc et al.

Incorrect answers:
Answers 1, 2, 3 and 5. Foot oligodactyly, femoral shortening, cruciate deficience and DDH are all associated with fibular hemimelia. It is primarily a lower extremity condition.