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Introduction: Amongst low- to middle income countries (LMIC), outdated and poorly documented orthopedic interventions may pose patients at risk for complications, serious adverse events (SAE) and unsatisfactory results, contradicting the World Health Organization's (WHO) Safe Surgery mandates. Use cases of conditions managed inadequately in LMIC environments are necessary to increase awareness of stakeholders and overcome deficiencies in collaboration with high-income countries (HIC). Materials and methods: Methodological and clinical experts from the BG Kliniken and the Charité, Berlin, Germany, were invited to investigate established processes for musculoskeletal disorders and injuries in Tashkent, Uzbekistan. Congenital lower leg discrepancy due to fibular hemimelia was recognized as an illustrative example to prove the effectiveness of local treatment guidelines, still relying on distraction epiphyseolysis (chondrodiatasis) via an Ilizarov frame. Routine data from hospital records, images and outpatient follow-up examinations were compared to estimates from a review of studies of limb-lengthening by other techniques. Results: Data from 16 of 49 immature patients (10 males, 6 females, mean age at surgery, 4.2 ± 2.3 years) undergoing chondrodiatasis between 2017 and 2021 showed a mean limb elongation of 2.4 (95% confidence interval [CI], 1.9 to 2.9) cm after a median follow-up of 29 (range, 24 to 36) months. While no complications or SAE were noted, findings are compatible with a risk of 21% under an upper 97.5% confidence limit for null events. No reproducible classification of hemimelia, surgical or general complications, assessment of functional outcomes or health-related quality of life were available. The pooled average length gain from 21 studies on different other interventions with osteotomy enrolling 458 limbs was 5.1 (95% CI, 5.0 to 5.3) cm. Conclusions of the use case: Limb lengthening for hereditary fibular hemimelia in Uzbekistan revealed rather obsolete surgical algorithms, inadequate documentation, and unreliable outcome assessment. Resource limitations notwithstanding, knowledge transfer, implementation of current procedures and hardware, and international collaboration is vital to improve quality of care in this scenario and for the benefit of LMIC in general. [ABSTRACT FROM AUTHOR]

There is no universal agreement on the best course of action for treating lower limb abnormalities, which can be managed with either amputation or limb reconstruction. In patients with lower limb abnormalities, this meta-analysis compared patient satisfaction and surgical complications between amputation and limb reconstruction. A systematic search was done to find studies contrasting lower limb amputation and limb repair. MEDLINE, Cochrane Registry of Clinical Trials, EMBASE, PubMed, Google Scholar, CINAHL, and Elsevier Scopus databases were searched using keywords (amputation and reconstruction) and (Fibula hemimelia or Fibula deficit or Fibular deformity) (therapy or treatment or management). Patient satisfaction and surgical complications were the main results. The odds ratio (OR) for patient satisfaction and the percentage of surgical problems per limb were calculated using a random-effects model. The meta-analysis includes seven trials that covered 202 patients in total. With an OR of 6.8, patients who had limb amputations reported higher levels of treatment satisfaction than those who had limb reconstructions. Additionally, the OR of 28 showed that the rate of surgical complications was much lower in the amputation group compared to the limb reconstruction group. In comparison to patients who underwent limb reconstruction, patients who had amputations reported higher levels of satisfaction and a lower risk of postoperative complications. According to these findings, amputation might be a better course of action for some patients with lower limb abnormalities. [ABSTRACT FROM AUTHOR]

Purpose: Fibular hemimelia has denoted a spectrum of postaxial longitudinal deficiency with fibular aplasia/hypoplasia; the term "terminal hemimelia" is reserved for patients with postaxial longitudinal deficiency having a normal fibula. We aimed to delineate the characteristics of terminal hemimelia. Methods: In total, 30 patients with postaxial longitudinal deficiency who had a normal or hypoplastic fibula and visited our institution between 1992 and 2022 were reviewed. Patients were divided into terminal hemimelia and classic fibular hemimelia groups, and their demographic characteristics and clinical and radiographic findings were compared. Results: Femoral shortening, knee valgus, and tibial spine hypoplasia were less common in terminal hemimelia (n = 13) than in classic fibular hemimelia (n = 17) (p = 0.03, p < 0.001, and p = 0.003, respectively). None of the patients in the terminal hemimelia group exhibited knee instability, whereas 12% of patients with classic fibular hemimelia did. Ball-and-socket ankle and absence of lateral rays were commonly observed in both groups. However, tarsal coalition was observed less frequently in terminal hemimelia (p = 0.004). All terminal hemimelia patients exhibited a painless plantigrade foot without ankle instability. Despite limb-length discrepancy at maturity averaging 40.4 mm for terminal hemimelia and 67.0 mm for classic fibular hemimelia (p < 0.001), patients with terminal hemimelia, except for one, exhibited > 20 mm of limb-length discrepancy. However, 46% of them underwent limb-length equalization procedures, mostly single-stage tibial lengthening, at a mean age of 11.2 years. Conclusion: Terminal hemimelia may present with a milder phenotype than classic fibular hemimelia. It mainly overlaps with the symptoms of fibular hemimelia below the ankle joint and manifests as limb-length discrepancy. However, a considerable number of patients with terminal hemimelia required limb-length equalization procedures, for example single-stage tibial lengthening. Level of evidence: level IV. [ABSTRACT FROM AUTHOR]

Tibial hemimelia is a rare condition with a reported incidence of approximately one in one million live births. Although tibial hemimelia can vary its presentation, it often presents a shortened lower limb associated with deformities in the knee and ankle. The objective of this study is to present a case of tibial hemimelia and the surgical technique performed to correct the deformity and bone lengthening using a circular external fixator in several stages. A 15-year-old male patient was evaluated, presenting Jones type 3 tibial hemimelia (visible distal part, but no proximal) in the right lower limb associated with congenital clubfoot and ankle deformity. Studying and planning the patient’s case was essential to classify and define the best treatment. These treatments can be flawed and often reach amputation. In the case described, several surgical approaches were performed with the objective of reconstructions and deformity correction, followed by limb lengthening, presenting excellent results. Level of evidence IV; Therapeutic studies; Case Report.

Hemimelia denotes the partial or complete absence of the distal half of a limb. Ulna hemimelia, a rare congenital anomaly, involves the complete or partial absence of the ulna in the upper limb, with an incidence of 1 in 150,000. This condition has been classified into 4 types, with the rare Type 4 variant involving humeroradial synostosis. We present a unique case of bilateral complete ulna hemimelia, humeroradial synostosis, and oligodactyly, in an 11-month-old female with bilateral upper limb shortening and restricted elbow movement since birth. Clinical examination revealed bilateral upper limb shortening, medial deviation of both wrist joints, fixed extension of both elbow joints, and bilateral absence of the cubital fossa. Radiographs confirmed bilateral micromelia, absence of ulna, humeroradial synostosis, and oligodactyly. This case, exhibiting bilateral Type 4 ulna hemimelia with Class 1 humeroradial synostosis, is a complex variant, rarely reported, and the first documented in Ghana. It also highlights the importance of radiological assessment in ensuring accurate diagnosis. Long-term follow-up and potential surgical interventions are crucial for optimizing upper limb function in such cases.