Congenital longitudinal deficiency of the tibia.
Fifty-seven patients (seventy-one limbs) who had congenital longitudinal deficiency of the tibia (tibial hemimelia) were retrospectively categorized according to radiographic type (Types 1 through 4, as described by Jones et al.). At an average follow-up of nine years, fifty-six of fifty-seven patients walked independently. An ablative surgical procedure was performed on sixty-one of the seventy-one lower extremities. According to the classification of Jones et al., fifty-four limbs had a Type-1 (a or b) or Type-2 deficiency. In twenty-two of these extremities, disarticulation of the knee was performed; in twenty-five, a Syme amputation; and in one, a Chopart amputation. The ipsilateral foot was retained in six extremities that had a severe Type-1 or Type-2 deficiency. Medial transfer of the fibula (the Brown procedure) generally yielded less than satisfactory results; in ten of fourteen extremities, one or more additional operations were needed. Seventeen extremities were classified as having a Type-3 or Type-4 deficiency; Syme amputation was done in nine and Chopart amputation, in four. Despite satisfactory reconstruction of the ankle, a Syme amputation was necessary in most extremities that had a Type-4 deficiency because a major leg-length discrepancy was projected. In four limbs that had a Type-3 or Type-4 deficiency, the foot was retained.
Schoenecker
P L
PL
Shriners Hospital for Crippled Children, St. Louis, Missouri 63131.
Capelli
A M
AM
Millar
E A
EA
Sheen
M R
MR
Haher
T
T
Aiona
M D
MD
Meyer
L C
LC
D000328:Adult; D000671:Amputation, Surgical; D004188:Disarticulation; D005260:Female; D005500:Follow-Up Studies; D005532:Foot Deformities, Congenital / Q000150:complications / Q000000981:diagnostic imaging; D006801:Humans; D007223:Infant; D007866:Leg / Q000002:abnormalities / Q000601:surgery; D008297:Male; D011859:Radiography; D012189:Retrospective Studies; D013977:Tibia / Q000002:abnormalities* / Q000000981:diagnostic imaging / Q000601:surgery