Congenital longitudinal deficiency of the tibia

Abstract

We performed a clinical and radiographic review of 15 patients (19 limbs) with longitudinal deficiency of the tibia treated between 1981 and 2001. Ten limbs with Kalamchi type I deficiencies were managed by through-knee amputation. Five type II deficiencies were treated by foot ablation and tibiofibular synostosis, either at the same time or staged, but prosthetic problems may arise from varus alignment and prominence of the proximal fibula. Patients with type III deficiencies (four cases) were treated by foot ablation. Prosthetic problems relating to proximal or distal tibiofibular instability may necessitate additional surgical intervention.

Fig. 1.

Type II tibial deficiency. a Clinical photograph showing severe shortening associated with varus deformity. The foot is in equinovarus, with coexisting preaxial polydactyly. b The proximal tibia is well formed, and the lower leg is in varus despite the absence of fibular angulation. The fibular head is dislocated and has migrated proximally

Fig. 2.

Type III tibial deficiency. a The AP radiograph demonstrates a distal divergence, associated with a longitudinal deficiency of the foot. b A lateral radiograph in the same patient shows a severe equinus deformity. No proximal tibiofibular instability was identified