Fibular Hemimelia: Principles and Techniques of Management
Children with fibular hemimelia (FH) present with a short lower leg of varying degrees of severity, often accompanied by a wide range of associated anomalies of the ipsilateral foot, ankle, and knee. Mild cases need only appropriately timed contralateral epiphysiodesis. Moderate cases require tibial lengthening, with realignment of the ankle in selected cases. For severe cases, the choice comes down to amputation versus limb salvage. One of the biggest challenges in limb salvage is to obtain a plantigrade foot. For the stiff equinovalgus ankle (the most common severe manifestation of FH) special reconstruction techniques are recommended to achieve a plantigrade foot. The knee may require anterior or posterior cruciate ligament reconstruction. Knee valgus is often treated by growth modulation. Associated congenital femoral deficiency should be addressed, either with lengthening or with contralateral epiphysiodesis. In summary, treatment of FH must be individualized according to the needs and expectations of each family/child and the reconstructive options available regionally.