Limb lengthening and deformity correction by the Ilizarov technique in type III fibular hemimelia: an alternative to amputation.
BACKGROUND
Fibular hemimelia is partial or total aplasia of the fibula; it represents the most frequent congenital defect of the long bones. It usually is associated with other anomalies of the tibia, femur, and foot.


OBJECTIVE
We reviewed 32 patients with Type III fibular hemimelia treated by successive lower limb lengthening and deformity correction using the Ilizarov method. We had three aims; first, to analyze complications, including the need for reoperation. The second was to assess knee and ankle function, specifically addressing knee ROM and stability and function of the foot and ankle. The third was assessment of overall patient satisfaction.


METHODS
Thirty-two patients underwent 56 tibia lengthenings and 14 ipsilateral femoral lengthenings. Their mean age and mean functional leg-length discrepancy at initial treatment were 6.7 years and 6.2 cm, respectively. Activity level, pain, patient satisfaction with function, pain, and cosmesis, complications, and residual length discrepancy were assessed at the end of treatment.


RESULTS
The mean number of surgeries was six per case. The healing index was 44.9 days/cm. Although complications were observed during 60 lengthenings (82%), the highly versatile system overcame most of them. Nearly equal limb length and a plantigrade foot were achieved by 16 patients. For two patients, a Syme's amputation was performed. The outcome was considered satisfactory in 17 patients (53%) and relatively good in eight patients (25%).


CONCLUSIONS
The Ilizarov technique has satisfactory results for treatment of Type III congenital fibular hemimelia and can be considered a good alternative to amputation.


METHODS
Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.
Orthopedic Department, Alessandro Manzoni Hospital, Lecco, Italy.
Maurizio A
MA
Catagni
Makram
M
Radwan
Luigi
L
Lovisetti
Francesco
F
Guerreschi
Nabil A
NA
Elmoghazy
D000293:Adolescent; D000671:Amputation, Surgical; D000843:Ankle Joint / Q000503:physiopathology / Q000601:surgery; D002648:Child; D002675:Child, Preschool; D004480:Ectromelia / Q000145:classification / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D005360:Fibula / Q000002:abnormalities / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D018889:Ilizarov Technique / Q000009:adverse effects; D007223:Infant; D007231:Infant, Newborn; D007558:Italy; D007719:Knee Joint / Q000503:physiopathology / Q000601:surgery; D007870:Leg Length Inequality / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D023821:Limb Salvage; D008297:Male; D017060:Patient Satisfaction; D011859:Radiography; D016059:Range of Motion, Articular; D020127:Recovery of Function; D012086:Reoperation; D012189:Retrospective Studies; D013977:Tibia / Q000002:abnormalities / Q000601:surgery; D013997:Time Factors; D016896:Treatment Outcome