2005, Number 3
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Acta Ortop Mex 2005; 19 (3)
Bone lengthening in patients with fibular hemimelia
Montalvo GM, Cassis ZN, Harfush NA, Camacho FL, Rivera RA
Language: Spanish
References: 30
Page: 99-103
PDF size: 46.76 Kb.
ABSTRACT
Background. Fibular hemimelia Achterman-Kalamchi type II is a rare congenital deficiency and it may be associated with other deformities. Treatment includes amputation or leg lengthening. There are many studies that document the success of both procedures. The purpose of our study is to present the results of treatment by limb lengthening patients with this malformation. Methods. This review of 21 patients lengthened with an external fixator. It is based on the X-Ray and clinical data from The Shriners Hospital for Children, Mexico City Unit from January 1990 to December 2002. Six patients were excluded from the study: two because of complications from a previous surgery in another hospital, one patient was initially treated with prosthesis and three patients because of shortening and severe ankle deformities. We included fifteen patients with fibular hemimelia Kalamchi type II, 10 boys and 5 girls (15 limbs affected: 8 right and 7 left) with a mean age of 8.5 years at surgery (range 5.2 – 12.10). The mean leg length discrepancy before operation was 6.7 cm (range 4.2-13 cm) and the mean lengthening achieved was 5.9 cm (range 4-8). We utilized monolateral type fixator in 13 patients: on the tibia (10 cases) and on the femur (3 cases). One patient was lengthened with an anular fixator in the tibia, and one with three different settings: an orthofix prior to a Wagner and an Ilizarov type. Results. The results found were tibial angular deformities in four patients (9°-20°), procurvatum in 3 patients (23°-40°), valgus deformity at the ankle in 6 patients (20°-30°). There was one non union that required bone graft, 3 patients developed severe contractures at the ankle and knee joint that required muscle lengthening procedures. We concluded that satisfactory results can be achieved in lengthening of type II fibular hemimelia and that amputation should be considered in severe discrepancy and deformity of the affected limb.
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