Ankle reconstruction in type II fibular hemimelia

Abstract

Ankle reconstruction prior to limb lengthening for was performed in 13 patients with fibular hemimelia with complete radiological absence of the fibula (type II). There were different degrees of absence of metatarsal rays. The hindfoot deformity was a heel valgus in 12 patients and equinovarus in 1 patient. The patients' ages ranged from 9 to 26 months. Excision of the fibular anlage was performed with lateral subtalar and ankle soft tissue releases to restore the ankle and subtalar joint relationships. In all cases, the fibular anlage ended distally in a cartilaginous lateral malleolar remnant that was fused to the talus in two patients. This fibular remnant was advanced distally and fixed to the tibia with 2 Kirschner wires to recreate an ankle mortise. The period of follow-up ranged from 12 to 38 months. All patients had a stable ankle without tendency to valgus deformity or subluxation. The ankle range of movement was a mean of 27.3° plantarflexion (25-30) and 18° dorsiflexion (15-20). Reconstruction of the ankle in type II fibular hemimelia using advancement of the cartilaginous lateral malleolar remnant has produced encouraging results in the short-term but longer follow-up is needed.

Fig. 1

The operative steps: a Posterolateral incision. b Lateral soft tissue release of the ankle and Z-Plasty of peroneal tendons and tendo Achillis. c Excision of the underlying fibular anlage and release of the fibular remnant from its proximal displaced position. d Centralization of the ankle by putting the talus under the tibia and fixation by a transcalcaneal wire. e, f Fixation of the cartilaginous anlage to the tibia and talus using two transverse smooth K-wires. g Closure of the wound in layers

Fig. 2

Case example: 14-month-old boy with right fibular hemimelia. a Preoperative photographs of the patient. b Photographs of the patient after 18 months of follow-up with regained ankle range of motion