synonyms: Congenital absence of the fibula
Fibular Hemimelia ICD-10
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