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Postaxial Hypoplasia of the Lower Extremity

Stevens, Peter M. M.D.; Arms, Don M.D.

Journal of Pediatric Orthopaedics: March-April 2000 - Volume 20 - Issue 2 - p 166-172
Limb Lengthening

Summary: Congenital deficiency of the fibula may present a variety of patterns. In a series of 20 patients with this diagnosis, we have observed limb-length inequality and a spectrum of musculoskeletal anomalies involving the ipsilateral hip, femur, knee, tibia/fibula, ankle, and foot. Considering the frequently associated abnormalities of the lower extremity, the term postaxial hypoplasia may be more descriptive than the traditional terms fibular hemimelia or fibular a/hypoplasia. By raising the awareness of associated deformities, the clinician is better prepared to advise patients and to intercede accordingly. Based on our experience, we advocate a modular treatment approach combining limb lengthening with hemiepiphysiodesis of the distal femur and/or ankle to correct valgus alignment and establish a neutral mechanical axis. Contralateral epiphysiodesis as an adjunct may be preferable to double or repeated lengthening. The goal is to achieve symmetry and stable joints at skeletal maturity with a minimal number of well-timed surgical interventions. By using this strategy and with minimal morbidity, 10 of our patients who have reached skeletal maturity have achieved a satisfactory outcome.

Study conducted at the University of Utah, Salt Lake City, Utah, U.S.A.

Address correspondence and reprint requests to Dr. P. M. Stevens, 100 North Medical Drive, Suite 4550, Salt Lake City, UT 84113, U.S.A.

From the University of Utah, Salt Lake City, Utah, U.S.A.

Copyright © 2000 Wolters Kluwer Health, Inc. All rights reserved.