Fibular hemimelia is the complete absence of the fibula. Sometimes there is a shortening of it. Being rare (0.3 per 10,000 live births) it is the most common of the congenital absences that can affect the long bones of the extremities.
Why does it occur?
Its cause is not known with certainty, and it is probably due to a vascular disorder that affects the development of the fibula. No hereditary or toxic factors have been identified. It can be accompanied by other malformations or bone absences in the same or in the other limb.
How is it diagnosed?
A series of signs can indicate that we are facing a fibular hemimelia:
- There’s a fibrous band instead of the fibula.
- The leg is small and misshapen.
- Absence of the lateral part of the ankle (due to the absence of the distal end of the fibula) and instability of the remaining part; the foot has a clubfoot deformity (it is a congenital defect in which the foot is turned, usually downwards and inwards).
- Sometimes, part of the foot is missing.
- Sometimes the foot can be used normally; in other cases, it must be amputated.
Types
Broadly speaking, we have three options:
- Complete absence of the fibula (type II)
- Partial (types IA and IB)
Which is the treatment?
Treatment will depend on the degree of involvement and can be orthopedic or surgical.
The most important thing is that the treatment be as early as possible and appropriate because these children have problems standing or walking and we must ensure that they do so when it corresponds to them in their evolutionary development.
The treatment must be multidisciplinary, that is, with different specialists:
- Pediatric Orthopedic Surgeon
- Physical therapist
- Orthopedic technician
This medical team will develop a plan to help your child get up and stay up, walk, and play like other children. We must seek the maximum normality possible.
Orthopedic treatment
The affectation is partial and unimportant, there is not much difference in the length of both legs. In those cases, it is enough for the children to use a special shoe or an insole . But most children need surgery.
Surgical treatment
Basically we have two technical options:
- It is done on the longer leg and consists of slowing or stopping the growth of the longer leg so that the shorter leg can reach a similar length. How? By closing the area of bone growth with a metal device. It can be done on the femur and/or the tibia.
- Progressive lengthening of the leg. A device is placed that can be external or internal (inside the bone) to progressively increase the growth of the leg. With it we lengthen the bone little by little by turning the bars and cylinders.
Only in very extreme cases is there no choice but to partially amputate the leg and fit a prosthesis.
What is the role of parents in these diseases?
Essential of course:
- Having a direct relationship with the entire medical team .
- Accompanying, if possible both parents, the child to all consultations.
- When he is old enough, explain the disease, the situation and everything that is being done to him so that he leads a life as normal as possible.
What you should know…
With this name we refer to the complete congenital absence of the fibula. Sometimes there is a shortening of it.
The treatment must be multidisciplinary, that is, with different specialists: child orthopedic surgeon, physiotherapist and orthopedic technician.
Treatment will depend on the degree of involvement and can be orthopedic or surgical. Only in very extreme cases is there no choice but to partially amputate the leg and fit a prosthesis.
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