Management of Fibular Hemimelia Using the Ilizarov Method at Siriraj Hospital in Thailand
Prangthong Unprasert MD*, Kamolporn Kaewpornsawan MD*, Chatupon Chotigavanichaya MD*, Perajit Eamsobhana MD*
Affiliation : * Department of Orthopedic Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
Background : Fibular hemimelia is one of the most common congenital longitudinal bone deficiencies. Previous treatment
protocols called for amputation of the deficient limb; while others made attempts to save the limb. The objective of treatment
is to restore function and achieve patient satisfaction. The authors evaluated the outcomes of the Ilizarov technique for the
treatment of leg-length discrepancy and bone associated deformities in patients with fibular hemimelia. The present study also
evaluated and assessed complications, knee and ankle function, and patient satisfaction with the treatment.
Material and Method: Nine patients with fibular hemimelia who underwent tibial lengthening using the Ilizarov method were
reviewed in the present study. Initial condition data, including age, gender, type of fibular hemimelia, initial limb-length
discrepancy, predicted limb-length discrepancy, and the data were collected and analyzed. Activity level, patient satisfaction,
complications, and residual leg-length discrepancy were assessed at the end of treatment.
Results : According to Achterman and Kalamchi classification, there were 4 patients with Type IA, 3 patients with Type IB, and
2 patients with Type II. In Type IA, the affected leg-length discrepancy and mean age at the initial treatment were 3.25 cm and
7.75 years, respectively. In type IB, the affected leg-length discrepancy and mean age at the initial treatment were 5.83 cm and
4.3 years, respectively. In Type II, the affected leg-length discrepancy and mean age at the initial treatment were 5.5 cm and
5 years, respectively. The mean follow-up was 5 years (range: 7-10). The mean lengthening was 7.52 cm (range: 4-13). The
lengthening index was 1.28 mo/cm. The mean residual leg-length discrepancy was 0.94 cm. There was ankle joint stiffness
and mild equinous foot in type II cases, but patients could walk well without gait aid. No patients were experiencing pain by
the end of treatment. All patients expressed satisfaction with this technique.
Conclusion : The Ilizarov technique for bone lengthening of the tibia has shown satisfactory results in the treatment of all
types of congenital fibular hemimelia and should be considered an attractive alternative to amputation, as measureable
functional improvement can be expected.
Keywords : Fibula hemimelia, Leg-length discrepancy, Ilizarov method, Syme’s amputation
