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Fibular Hemimelia 755.37

 

synonyms: Congenital absence of the fibula

Fibular Hemimelia ICD-9

  • 755.37 longitudinal defiency, fibular, complete or partial

Fibular Hemimelia Etiology, Natural History

  • range from complete absence of the fibula with missing lateral rays of the foot (i.e. terminal longitudinal deficiency) to absence of only a portion of the fibula without foot involvement (i.e. intercalary longitudinal; deficiency).
  • usually occurs sporadically without a known cause.

Fibular Hemimelia Clinical Evaluation

  • anterolateral bow of the tibia, an equinovalgus deformity of the foot, and a tarsal coalition.
  • The talotibial joint is usually malformed, with the fused talocalcaneus having a flat upper surface that articulates with the tibia in a valgus and equinus position.
  • The foot may be missing one or two lateral rays.
  • There is always significant shortening of the ipsilateral femur.

Fibular Hemimelia Treatment

  • complete fibular hemimelia = ankle disarticulation in early childhood and fitting a Syme-type prosthesis.
  • Consider limb-lengthening techniques for cildren with lesser (<5cm) discrepancy at birth.
  • Children with large discrepancies (>5cm) at birth and those with major foot deformities are better managed with amputation.

Fibular Hemimelia References

  • Herring JA: The Limb-Deficient Child, in Morissy RT, Weinstein SL (eds) Pediatric Orthopaedics, ed 4. Philadelphia, PA, Lippincott-Raven, 1996, pp 1149-1154.
  • Walker JL, JBJS 2009;91:797

 

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