Case report: Single-session double-Ilizarov lengthening technique in the treatment of a child with congenital fibular deficiency

Abstract

Background: Congenital fibular deficiency is a rare disease with a broad spectrum of deformities. Associated anomalies complicate the symptoms of patients and, consequently, individualized treatments that aim at normal function and acceptable appearance.

Case presentation: We present a case of congenital femoral and fibular shortening in the right lower limb with foot anomaly at school age. The patient underwent limb lengthening procedure in a single session on the right femur and tibia at the same time using a double-Ilizarov frame. The functional and cosmetic of his right lower extremity achieved a good outcome. Complications were minimal except for the superficial infection. Treatment lasted for 9.2 months, allowing for returning the patient to functional activity as soon as possible.

Conclusion: A satisfactory result was obtained with limb lengthening in a single session using double Ilizarov external fixators in a school-aged patient with congenital fibular deficiency.

Keywords: child; congenital fibular deficiency; double-Ilizarov lengthening technique; ipsilateral; single session.

Figure 1

Anteroposterior X-ray view. (a) An 11.5-year-old boy showed congenital fibular deficiency with a total 8.8 cm shortening of the right femur and tibia, genu valgus, and was missing lateral feet in an equinovalgus position. (b) A double Ilizarov frame, including a femoral segment and a tibial segment, were connected with two straight/flexure device on the level of the knee joint. (c) The bony callus was observed almost consolidated 28 weeks after operation after lengthening, lasting for 5 weeks on the femur and 8 weeks on the tibia. (d) After 40 weeks of the operation, the double-Ilizarov frame was removed. (e) At a 3.5-year postoperative follow-up, the limb length discrepancy was 1.5 cm.

Figure 2

Physical examination at 3.5-year postoperative follow-up. There was a 1.5 cm limb length discrepancy cosmetic of his right lower extremity (a,b). The flexion functional examination of the right knee showed moderate restriction (c,d).