Fibular Hemimelia

Therapy

Treatment varies depending upon the severity of the disorder. The first step is to reduce the malposition of the foot. In babies, this is achieved by treatment with a cast or splint. Later, the cast can be replaced by orthoses. Depending on the stability of the knee, this will be a lower leg orthosis or a thigh brace.

At the age of approximately 12 months, the young patient should in any case be prepared so far (with heel lifts or orthosis) that he can start walking freely, appropriate for his age.

If a major leg length discrepancy is to be expected at the start of puberty, then leg lengthening by means of external fixation may be considered. The decision for such an operation should be made as early as possible, since this is of psychological advantage both for parents and child. Treatment with a ring fixator permits the simultaneous correction of the complex leg and foot deformities that are associated with the fibular defect. Depending on the severity of the disorder, this operation may have to be repeated at a later time. If the difference in leg length and the axial deformity are not particularly pronounced, the possibility of an epiphysiodesis (surgical blocking of the growth plate) may be considered for temporarily directing growth.

Approximately at the age of 6 years, the problem of knee instability has to be faced, in order to avoid an early occurrence of degenerative joint damage in these children.

Although the treatment with an external fixator always means high psychological stress both to the children and the parents, it should be taken into account that this treatment method means only a temporary impairment. Amputation, on the other hand, means a final condition.

Sample treatment schedule

0 - 10 months Consultation, casts,  radiographs if necessary, cutting the residual fibular fragment

7 Mon. - 1 Year Treatment with orthosis,
MRI for imaging pathological changes (fibula, bone malformation, interior knee)

1 - 3 years If necessary, resection of the residual fibular fragment / heel lift / correction of the distal misalignment  with wedge osteotomy and K-wire fixation and thus, a 1st axial correction

3 - 5 years 2nd axial correction and if applicable, lengthening with external fixator. If needed, also temporary epiphyseodesis after the 5th year of life.

starting from 7 years of age If applicable, anterior cruciate ligament reconstruction. If needed, also temporary epiphyseodesis

8 - 11 years If applicable, further axial correction and lengthening.  If needed, also temporary epiphyseodesis

12 - 15 years If necessary, growth stop opposite side

  After conclusion of growth (> 14-16 years): final axial correction and lengthening
   

Erfahrungsberichte