Fibular hemimelia treated by autologous osteoblasts: a case report
Abstract
F ibular hemimelia (FH) is the complete or partial absence of the fibula with an incidence of seven to 20 per 1,000,000 live births. Femoral and tibial hypoplasia results in limb-length discrepancy (LLD), which becomes an obvious deformity by adulthood with grossly compromised quality of life. Several classification systems have been developed for FH; the most common is by Achterman and Kalamchi describing the amount of fibular discrepancy in patients. It is now reported that the LLD does not correlate with the amount of fibula deformity. Thus, the more recent Paley classification system gives priority to foot and ankle deformity that is associated with FH. Various studies reported amputation to be a successful method in the form of foot ablation and prosthetic fitting in treating FH. Similarly, different limb reconstruction procedures also showed favorable results in many studies. Both treatments aim to achieve functional correction of the affected limb, with a plantigrade, stable, and flexible foot. Amputation is recommended for more severe FH cases. Limb reconstruction procedures are used in mild to moderate cases, and multiple corrective surgeries need to be planned over several years in childhood. The most common corrective surgery is distraction osteogenesis (DO) with the use of an Ilizarov apparatus as an external fixator; however, recurrence rates are high with this technique. Surgical procedures are limited by long treatment times that are not well tolerated by…
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