The outcome of the use of Ilizarov technique in the management of congenital fibular hemimelia: Review of cases admitted to Erbil Teaching Hospital in Kurdistan region of Iraq
Background and objective: Patients affected by fibular hemimelia primarily presented clinically as foot deformities and limb length discrepancies. Surgical restoration of normal limb alignment and length has been reached by using Ilizarov technique. This study aimed to determine the outcome of using Ilizarov procedure in the management of lower limb discrepancy cases in Erbil.
Methods: This study is a review of fibular hemimelia cases managed at the orthopedic department of Erbil Teaching Hospital between November 2014 and June 2018. Fibular hemimelia patients complaining from lower limb shortening of 3–11 cm were included in this study. All patients were examined pre and post application of Ilizarov procedure to determine the range of lower limb motion by using the lower extremity functional scale. Ilizarov operative technique was used for the correction of deformities and restoration of normal limb length and alignment.
Results: Eight fibular hemimelia patients, including three males, were enrolled in the study with a mean (±SD) age of 7.37 ± 4.13 years (range from 3 to 16 years). They had a mean limb shortening of 6.06 ± 2.36 cm. A wide range of residual deformities and congenital anomalies was reported among fibular hemimelia cases. A number of residual deformities and complications were associated with Ilizarov technique affecting the knee joint, proximal tibia, and ankle joint. Improvement in the lower extremity functional scale from quite a bit and moderate difficulty to a little bit of difficulty (P <0.001) between the two means of pre and postoperative lower extremity functional scale was demonstrated.
Conclusion: Ilizarov procedure is effective in improving the lower extremity function in fibular hemimelia despite the associated complications and leg length inequality.
Paley D. Surgical reconstruction for fibular hemimelia. J Child Orthop 2016; 10(6):557–83.
Hamdy RC, Makhdom AM, Saran N, Birch J. Congenital fibular deficiency. J Am Acad Orthop Surg 2014; 22(4):246–55.
Rafiq OA, Amen ZJ. Managment of fibular hemimelia (congenital absence of fibula) using Ilizarov method in Sulaimani. Eur Sci J 2015; 11:304–16.
Changulani M, Ali F, Mulgrew E, Day JB, Zenios M. Outcome of limb lengthening in fibular hemimelia and a functional foot. J Child Orthop 2010; 4(6):519–24.
Kulkarni R. Management of fibular hemimelia using Ilizarov method. In: Kulkarni GS, editor. Textbook of orthopedics and trauma. 2nd ed. New Delhi: Jaypee brothers medical publishers; 2008. P. 1686–91.
Shahcheraghi GH, Javid M, Hadavi F. Pediatric lower limbIlizarovlengthening with functional evaluation in adulthood: A report onunder privileged patients. J Orthop 2015; 12(Suppl 1):S69–74.
Kelly DM. Congenital anomalies of the lower extremity. In: Canale ST, Beaty JH, editors. Campbell's operative orthopaedics. 12th ed. Philadeliphia: Elsevier Mosby; 2013. P. 980–1077.
Birch JG, Samchukov ML. Use of the Ilizarov method to correct lower limb deformities in children and adolescents. J Am Acad Orthop Surg 2004; 12:144–54.
Vargas Barreto B, Caton J, Merabet Z, Panisset JC, Pracros JP. Complications of Ilizarovleg lengthening: a comparative study between patients with leg length discrepancy and short stature. Int Orthop 2007; 31(5):587–91.
Jordan C J, Goldstein RY, McLaurin TM, Grant A. The evolution of the Ilizarov technique. Part1: the history of limb lengthening. Bull Hosp J Dis 2013; 71(1):89–95.
Sabharwal S, Rozbruch SR. What's new in limb lengthening and deformity correction? J Bone Joint Surg Am 2011; 93:2323-32.
Schep NWL, van Lieshout EMM, Patka P, Vogels LMM. Long-term functional and quality of live assessment following post-traumatic distraction osteogenesis of the lower limb. Strategies Trauma Limb Reconstr 2009; 4(3):107–12.
Binkley JM, Stratford PW, Lott SA, Riddle DL. The lower extremity functional scale (LEFS): scale development, measurement properties, and clinical application. North American Orthopaedic Rehabilitation Research Network. Phys Ther 1999; 79(4):371–83.
Paley D, Pfeil J. Principles of deformity correction around the knee. Der Orthopade 2000; 29(1):18–38.
Rose R. Tibial lengthening using the classic Ilizarov technique. The IJOS 2009; 16(1):1–5.
Cheng JC, Cheung KW, Ng BK. Severe progressive deformities after limb lengthening in type-II fibular hemimelia. The J Bone Joint Surg Br 1998; 80(5):772–6.
Başbozkurt M, Yildiz C, Kömürcü M, Demiralp B, Kürklü M, Ateşalp AS. Management of fibular hemimelia with the Ilizarov circular externalfixator. Acta Orthop Traumatol Turc 2005; 39(1):46–53.
Unprasert P, Kaewpornsawan K, Chotigavanichaya C, Eamsobhana P. Management of fibular hemimelia using the Ilizarov method at Siriraj hospital in Thailand. J Med Assoc Thai 2014; 97 Suppl 9:S44–9.
Catagni MA, Radwan M, Lovisetti L, Guerreschi F, Elmoghazy NA. Limb lengthening and deformity correction by the Ilizarov technique in type III fibular hemimelia: an alternative to amputation. Clin Orthop Relat Res 2011; 469(4):1175–80.
Alaseirlis DA, Korompilias AV, Beris AE, Soucacos PN. Residual malformations and leg length discrepancy after treatment of fibular hemimelia. J Orthop Surg Res 2011; 6:51.
Mishima K, Kitoh H, Iwata K, Matsushita M, Nishida Y, Hattori T, et al. Clinical results and complications of lower limb lengthening for fibular hemimelia. Medicine 2016; 95(21):e3787.
Da Silva RR, Matos MA, Pimentel M, Martins BJ, Oliveira RV. Severe valgus deformity of the knee joint: description of the new surgical technique for its correction. Rev Bras Orto 2012; 47(2):251–6.
Mishima K, Kitoh H, Iwata K, Matsushita M, Nishida Y, Hattori T, et al. Clinical results and complications of lower limb lengthening for fibular hemimelia. Medicine (Baltimore) 2016; 95(21):e3787.
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
The copyright on any article published in Zanco J Med Sci is retained by the author(s) in agreement with the Creative Commons Attribution Non-Commercial ShareAlike License (CC BY-NC-SA 4.0).