Outcome of limb lengthening in fibular hemimelia and a functional foot.

BACKGROUND: The decision to recommend either reconstructive or ablative surgery to the parents of children with fibular hemimelia is difficult and debatable in the orthopaedic literature. METHODS: This is a retrospective study reporting our experience of the treatment of eight children (eight limbs) with fibular hemimelia with limb lengthening using Ilizarov or Taylor spatial frames. All of these children had type 1 or 2a fibular hemimelia (Achterman and Kalamchi). We used the number of rays present in the foot as a guide to decide on the treatment option. Children with more than three rays at the time of presentation were considered for limb reconstruction using Taylor spatial or Ilizarov frames. RESULTS: All patients were ambulatory and mobile with acceptable leg lengths and limb alignment at the time of last follow-up. All of them were satisfied with the outcome. Knee stiffness was a significant problem in the majority of the patients following lengthening. CONCLUSIONS: We conclude that limb reconstruction in children with less severe forms of fibular hemimelia is a good option.