Bilateral Calcaneus Transfers for the Treatment of Congenital Tibial Deficiencies: A Novel Surgical Technique and Case Report

Abstract

Tibial deficiency (also known as tibial hemimelia) is a rare condition with variable presentation. A 2-month-old patient presented with absent bilateral tibias. When the patient was 1 year, a novel reconstructive surgery was done. A bilateral fibular resection with pedicled calcaneus transfer was done, allowing for transfer of the calcaneus along with the overlying glabrous skin and soft tissues to the end of the femur. The patient was permitted to weight-bear after the 4-week postoperative follow-up. At the six-month follow-up, the patient was able to pull to stand and walk with assistance without any reports of pain.

Figure 1

Preoperative image demonstrating shortened bilateral lower extremities with pterygiums and tibial deficiencies.

Figure 2

Radiographic anterior-posterior imaging when the patient was of 8 months. A, Right lower extremity demonstrating absent tibia with dislocation and severe flexion contracture of the knee and subluxation or dislocation of the ankle. B, Anterior-posterior view of the left lower extremity demonstrating absent tibia with dislocation or subluxation of the knee and dislocation of the ankle.

Figure 3

Intraoperative fluoroscopic anterior-posterior imaging of bilateral lower extremities. A, Right lower extremity demonstrating a smooth pin inserted through the calcaneus into the distal femur. B, Left lower extremity demonstrating a midshaft femur osteotomy with a smooth pin inserted through the calcaneus into the femur.

Figure 4

Postoperative image after bilateral calcaneal transfers and soft-tissue rearrangement.

Figure 5

Radiographic anterior-posterior imaging of bilateral lower extremities at 1 month after procedure. A, Right lower extremity image demonstrating good alignment of the calcaneus and femur with bony healing. B, Left lower extremity image demonstrating a midshaft femur osteotomy with callus formation and appropriate alignment of the calcaneus and femur.

Figure 6

Photograph of the patient at the 4-week postoperative follow-up with prescribed Stubbies for weight-bearing activities.

Figure 7

Photograph at the 8-week postoperative follow-up revealing adequate wound healing.

Figure 8

Radiographic anterior-posterior imaging of bilateral lower extremities at 9 months after the procedure, demonstrating cartilage-on-cartilage apposition of the distal femur and calcaneus. A, Right lower extremity demonstrating good alignment of the calcaneus and femur. B, Left lower extremity demonstrating healed midshaft femur osteotomy with appropriate alignment of the calcaneus and femur.