Ankle reconstruction in fibular hemimelia

Abstract

Fibular hemimelia is a congenital condition characterized by partial or total absence of the fibula. Rarely is it an isolated event, and deficiency of other long bones in the same limb is common. In fact, these other subtle deficiencies in the same limb have led to the consideration of the disease as being a 'syndrome' rather than a single long bone deficiency. Even the fibula itself shows a very wide spectrum of deficiency ranging from the almost unrecognizable deficiency where the fibula is present but mildly hypoplastic, to the complete fibular absence with marked foot deformity and severe limb shortening. The fibula is the most commonly deficient long bone with an incidence of 1.07 per 10000 live births. Next in line is deficiency of the femur, the radius and the tibia. The classic picture is that of a new born baby with a short limb, a tibia that is bowed anteriorly with a skin dimple at the apex of the bowing, an ankle thrust into a rigid equinovalgus position and a foot with missing two lateral rays.