Please confirm topic selection

Are you sure you want to trigger topic in your Anconeus AI algorithm?

Please confirm action

You are done for today with this topic.

Would you like to start learning session with this topic items scheduled for future?

Updated: Jun 14 2021

Tibial Deficiency

Images hemimelia_moved.jpg hemi_moved.jpg
  • summary
    • Tibial Deficiency is a congenital condition characterized by a longitudinal deficiency of the tibia with varying degrees of tibial absence.
    • Diagnosis is made radiographically with xrays of the tibia. 
    • Treatment is a variety of surgical options depending on the extent of deficiency and stability of knee joint. 
  • Etiology
    • Genetics
      • autosomal dominant inheritance pattern
        • obtain genetic counseling
    • Associated conditions
      • musculoskeletal conditions present in 75% of patients
        • ectrodactyly
        • preaxial polydactyly
        • ulnar aplasia
  • Classification
    • Jones classification
      • Jones Classification
      • Type 1a
      • No proximal tibia visible on radiograph
      • Extensor mech absent
      • Hypoplastic distal femoral epiphysis
      • Type 1b
      • Proximal tibia eventually ossifies and extensor mechanism will function
      • Distal femoral epiphysis appears normal
      • Type 2
      • Proximal tibia present at birth but short tibia
      • Type 3
      • Diaphyseal and distal tibia present but proximal tibia absent
      • Type 4
      • Short tibia, fibula migrated proximal, diastasis of distal tib-fib joint
    • Alternate system is Kalamachi and Dawe (types 1-3)
  • Presentation
    • Physical exam
      • deformity
        • shortening of the affected extremity
        • anterolateral bowing of the tibia
        • prominent fibular head
      • ROM & stability
        • the knee is usually flexed with an associated knee flexion contracture
          • it is important to evaluate for active knee extension
        • check stability of the knee joint in all planes
          • treatment is based primarily on the stability of the knee joint
      • foot deformity
        • there is often a rigid equinovarus and supination deformity of the foot
        • sole of foot faces perineum
  • Imaging
    • Radiographs
      • recommended
        • AP and lateral tibia/fibula
      • findings
        • show deficiency of the tibia
        • early radiographs may show small and minimally ossified distal femoral epiphysis
  • Treatment
    • Operative
      • knee disarticulation followed by prosthestic fitting
        • indications
          • complete absence of the tibia
          • no active knee extension present (most cases)
      • tibiofibular synostosis with modified Syme amputation
        • indications
          • proximal tibia present with intact extensor mechanism and minimal flexion contracture
      • Syme/Boyd amputation
        • indications
          • ankle diastasis
      • Brown Procedure (centralization of fibula under femur)
        • no longer recommended due to high failure rate
1 of 3
1 of 1
Private Note

Attach Treatment Poll
Treatment poll is required to gain more useful feedback from members.
Please enter Question Text
Please enter at least 2 unique options
Please enter at least 2 unique options
Please enter at least 2 unique options