Hemimelia of the tibia associated with congenital dislocation of hip and knee,and clubfoot. Reconstruction with osteotomy and translation of the fibula.About a case

Abstract

A newborn was treated with right tibial hemimelia who presented hip dislocation, knee dislocation and clubfoot on the same
side. No other similar patient was found in the published literature. We classified the hemimelia as type IV A, according
to Paley's classification. The knee and hip dislocation were resolved with surgery since conservative treatment failed and
to reconstruct the ankle, the foot was lowered with an Ilizarov fixator, a talar fibular fusion was performed and the fibula
was osteotomized at the level of the beginning of the tibial diaphysis, the fibula was moved under the tibia and everything
was stabilized with an intramedullary nail. The result was satisfactory. The foot is plantigrade and the hip and knee have
normal range of motion. The discrepancy will be corrected with tibial lengthening later according to the life plan made. We
believe that realignment of the foot under the fibula and translation of the fibula with the tibia is an excellent option for the
treatment of hemimelia with distal tibial defect. The low incidence of this pathology and the high variability of presentations
make it difficult to standardize a surgical plan and an individualized analysis and plan must be made for each patient.