Search

Introduction: Amongst low- to middle income countries (LMIC), outdated and poorly documented orthopedic interventions may pose patients at risk for complications, serious adverse events (SAE) and unsatisfactory results,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.

Gollop-Wolfgang complex is defined as the presence of a distal bifid femur and tibial hemimelia with or without hand ectrodactyly. The condition commonly presents with several skeletal abnormalities and internal organ congenital defects. We hereby report a case with a classical presentation of Gollop-Wolfgang complex.

Gollop-Wolfgang complex (GWC) is a rare musculoskeletal anomaly consisting of unilateral femur bifurcation, ipsilateral tibial agenesis, and ectrodactyly. Only very few authors have reported GWC in neonates and mostly with the involvement of unilateral lower limb. Herein, we report a very rare case of neonate having bilateral femoral bifurcation and bilateral tibial agenesis with intact fibula.

Radial dysplasia congenital defect resulting in shortening of the forearm due to congenital shortening of the radius. Isidore Geoffroy Saint-Hilaire coined the term "hemimelia" around 18361837. Affected individuals may also have reduced limb functions abnormalities of the soft tissues, vasculature of the forearm. The management consist of splinting, stretching, and centralization. Physical therapy management plays a vital role in regaining hand function and improving quality of life. In severe cases, surgical correction such as osteotomy. Radial hemimelia is a rare disorder with 1/5000-30,000 live birth. A 16-year-old girl was admitted to Acharya Vinoba Bhave Rural Hospital (AVBRH) with complaints of weakness of the right upper limb along with a tingling sensation from the past 1 year. She was operated on with ulnar osteotomy and physical therapy management was initiated which consists of regaining mobility and strength and making the patient functionally independent. We concluded that a well structure physical therapy protocol along with medical therapy post-surgery improved the overall status of the patient. [ABSTRACT FROM AUTHOR]

Gollop-Wolfgang complex (GWC) is a rare musculoskeletal anomaly consisting of unilateral femur bifurcation, ipsilateral tibial agenesis, and ectrodactyly. Only very few authors have reported GWC in neonates and mostly with the involvement of unilateral lower limb. Herein, we report a very rare case of neonate having bilateral femoral bifurcation and bilateral tibial agenesis with intact fibula. [ABSTRACT FROM AUTHOR]

Objective: To review indications for limb amputation or reconstruction using the SUPERankle procedure in patients diagnosed with Paley type 3 or 4 fibular hemimelia; To evaluate the correction of deformities needed to achieve a stable plantigrade foot, review variations of the original technique and their applicability, and describe challenges encountered in their execution. Methods: Qualitative, retrospective, descriptive study of 4 patients who underwent the SUPERankle procedure between 2019 and 2020 for treatment of foot and ankle deformities in fibular hemimelia. Pre- and postoperative clinical and radiographic evaluations were performed to identify objective evidence of the correction of foot and ankle deformities. The operative techniques employed are described. Results: The included patients met anatomical and psychosocial criteria for reconstruction, as established in the literature. Clinical correction of foot and ankle deformities was achieved, but on radiographic evaluation, there was no statistical difference; this was likely due to the small number of patients, given the rarity of fibular hemimelia. Conclusion: The procedure is reproducible, but requires a knowledgeable, well-trained surgical team. Correction of foot and ankle deformities can be achieved. The choice between amputation or reconstruction should be the result of an informed decision by Family members, supported by a multidisciplinary team. Level of Evidence IV; Qualitative Study; Case Series.

Gollop-Wolfgang complex is defined as the presence of a distal bifid femur and tibial hemimelia with or without hand ectrodactyly. The condition commonly presents with several skeletal abnormalities and internal organ congenital defects. We hereby report a case with a classical presentation of Gollop-Wolfgang complex. [ABSTRACT FROM AUTHOR]

Alterações na embriogênese podem produzir anomalias na estrutura ou função dos tecidos e órgãos e essas podem ser de origem genética ou ambiental. O processo conhecido como organogênese, dependerá da interação entre endoderma, mesoderma e ectoderma, que originará movimentos celulares posteriores, através da migração de células precursoras com a formação dos botões dos membros e assim acarretando na citodiferenciação, ou seja, na formação dos membros propriamente ditos. As disostoses, que são o conjunto de alterações morfológicas congênitas caracterizam-se pelo desenvolvimento anormal de um osso ou de parte dele, que pode acometer o esqueleto apendicular. A agenesia ou também conhecida como hemimelia, consiste em uma anomalia de caráter raro na qual, um ou mais ossos pareados possuem ausência completa ou parcial, mas dentre essa raridade a de maior frequência é a hemimelia na forma unilateral. O relato de caso trata-se de um cão, sem raça definida, apresentando deformidade de membro torácico esquerdo, claudicação e sem conseguir apoiá-lo ao chão. Foram realizados exames radiográficos do membro consecutivamente, e que revelaram a presença de hemimelia longitudinal pré-axial intercalar associada à hipoplasia umeral. Optou-se por aguardar o desenvolvimento do animal para reavaliações clínicas e desenvolvimento de prótese no membro acometido.

Ulnar hemimelia is a very rare skeletal abnormality characterized by the total or partial absence of the ulna. It is reported to occur in approximately 1 per 150,000 live births. Some shortening of the forearm, radial bowing, and tendency of the hand to drift to the ulnar side of the wrist usually accompany ulnar hemimelia. Other skeletal anomalies such as humeroradial synostosis, radial head dislocation, carpal or metacarpal coalition, and digital abnormalities may also be seen in cases of ulnar hemimelia. The patients may be asymptomatic in the presence of an isolated mild ulnar deficiency. On the other hand, cases of prominent ulnar deficiency accompanied by complex upper limb abnormalities leading to severe disability may also be observed. We herein present four patients with varying degrees of ulnar hemimelia. Our first case had an isolated ulnar hemimelia, whereas the other three had additional upper limb abnormalities of different types. [ABSTRACT FROM AUTHOR]

Copyright of Neotropical Biology & Conservation is the property of Pensoft Publishers and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Isidore Geoffroy Saint-Hilaire coined the term "hemimelia" in the early 19th century, while in 1951, O'Rahilly suggested the term "paraxial hemimelia" for the longitudinal variety, because either the preaxial or postaxial side of the limb is involved. The deficiency can be transverse, longitudinal and sometimes combination of both. This case report highlights the finding of a case of ulnar intercalary hemimelia with multiple bilateral exostoses of the knee and the rehabilitation potential for the same. [ABSTRACT FROM AUTHOR]

Introduction: Birth defects still remain one of the major causes of economic wastage in livestock farming. It may be caused by a number of aetiologies. Meningoencephalocele results from neural tube defect during embryology. It is incompatible with life. Materials and methods: This is a case report of a stillbirth pig, which was presented with a swelling on the frontal part of the skull, and a number of other musculoskeletal defects. The affected piglet was farrowed with 5 other piglets by a 4 year old sow with previous uneventful farrowings. All other piglets in the litter showed no physical abnormalities post parturition. Results: Gross examination revealed meningocele with a circumference of 19 cm. Necropsy and x-ray (dorso-ventral view) revealed skeletal deformities which involved the long bones and the axial skeleton. The long bones were considerably shortened, with some having a 'twisted' appearance, while the vertebral column showed scoliosis. X-ray also revealed non-closure of the frontal bone of the skull, which resulted in herniation of brain material. Other abnormalities included bilateral anorchia, anophthalmos, cleft lip, atresia ani and multiple skeletal deformities. A rudimentary phallus was present, but dissection of abdominal and pelvic cavities revealed absence of any identifiable reproductive organs (male or female). Conclusion: Abnormalities observed were not compatible with life. This is probably the first electronically documented report of meningoencephalocele of the pig, with the reported accompanying multi organ and skeletal abnormalities in Nigeria. [ABSTRACT FROM AUTHOR]

Turner's syndrome (TS) is depicted as a total or partial absence of X chromosome, and occurs in approximately 1/2200 of live born females. Generally, mosaic patients are diagnosed following karyotype analysis due to recurrent pregnancy loss, repeated in vitro fertilization (IVF) failure, and a history of malformed babies. The purpose of this case report is to show that even a selection of normal karyotype embryos can result in abnormalities for those with mosaic TS. A 32-year old patient who underwent IVF after ICSI-PGD, and was diagnosed with 45X/46XX karyotype. At the 12-week scan, one of the fetuses had an upper limb hemimelia in one arm, and feticide was applied to that fetus. The patient delivered a healthy, 2980 g female baby at the thirty-eighth week. In mosaic TS pregnancies (even those obtained by ICSI-PGD), fetal anomaly risk is high. Therefore, careful prenatal scanning is needed for these pregnancies. [ABSTRACT FROM AUTHOR]

A 1-month-old, intact female domestic rabbit was presented with a history of acute right hind limb lameness due to a traumatic injury. Physical examination revealed right elbow luxation, varus deviation, and a reduction in antebrachial length. Radiographic imaging of the affected limb revealed lateral right elbow luxation, radial agenesis, right first digit agenesis, and malformation of the right carpal bones and sternum. The patient’s diagnosis based on the presenting clinical signs and radiographic evaluation was determined to be right preaxial longitudinal intercalary radial hemimelia, partial adactyly, and multiple bone malformations. Hemimelia is the most common congenital limb malformation in domestic animals. Clinical signs can be variable, ranging from subclinical to severe locomotion problems. Although it has not been reported in pet rabbits, hemimelia should be considered in the young of this species that present with lameness. Early diagnosis is essential to avoid muscle atrophy and worsening of bone deformities, which may adversely affect quality of life of the patient. [ABSTRACT FROM AUTHOR]

Hemimelia is a common congenital limb abnormality found in water buffaloes from Southern Italy. In humans, such defect has been associated with mutations in WNT7A and ESCO2 genes. These two candidate genes were analyzed by polymerase chain reaction in the genomic DNA extracted from the blood of buffaloes, and cows for control. No differences in WNT7A and ESCO2 sequences between affected and healthy buffaloes were identified. However, comparing sequences of control cows and buffaloes, WNT7A showed simple species polymorphisms, and ESCO2 showed seven base-pair substitutions. These results demonstrate that limb malformations in buffaloes are not related to congenital defects in WNT7A gene. Interestingly, our findings highlight for the first time differences in the sequences of WNT7A and ESCO2 genes between buffaloes and cows.

A 9-month-old 10 kg intact male crossbred dog was admitted to The Animal Medical Centre,ChonbukNationalUniversitywith congenitally malformed right forelimb. Physical exanimation of the limb showed varus deviation of the forepaw and flexion contracture of the interphalangeal joints. The survey radiographs revealed complete absence of the radius, poor congruency of the humeroulnar joint and 90° varus deviation of the ulnocarpal joint. A preaxial longitudinal intercalary radial hemimelia was diagnosed and the dog underwent 3 surgeries for correction of the deformity. During the first surgery, olecranon osteotomy and arthrodesis of the elbow were performed. Three months later, a second surgery was done to perform carpal panarthrodesis using bone plate and screws which was unsuccessful. Two weeks after, with a third surgery carpal arthrodesis was performed using acrylic frame, the distal portion of limb was straightened and the residual deviation of the forepaw was corrected. The surgical corrections resulted in satisfactory use of the limb and a better quality of life.

Abstract: Dysplasia epiphysealis hemimelica is a rare developmental disorder with unknown etiology affecting epiphysis mostly in childhood. Dysplasia epiphysealis hemimelica is usually considered an intra-articular variant of an osteochondroma owing to its presenting symptoms and histologic findings. Surgical treatment is mandatory when symptoms such as pain, joint impingement, or deformity are present and will yield good results when the mass is juxta-articular or extra-articular. In those cases in which the mass is intra-articular and surgical intervention could affect the growth of the epiphysis, surgical treatment should be carefully evaluated and considered. A case of recurrence of dysplasia epiphysealis hemimelica located in the distal tibial epiphysis and talus that was successfully treated with surgery is presented. [Copyright &y& Elsevier]

Abstract: Diplopodia is a rare congenital disorder that has not been extensively discussed in textbooks, and case reports appear to be the main source of information. Although the exact cause of diplopodia remains unknown, the presence of extra digits as well as metatarsals and tarsals allows it to be differentiated from pedal polydactyly. Syndactyly refers to the congenital fusion of the digits. Concomitant bilateral syndactyly and diplopodia is extremely unusual, and in this report we describe a case of right diplopodia and left polydactyly combined with bilateral manual syndactyly in a 15-year-old girl who was ultimately treated with through-the-knee amputation. Radiological examination of the right leg revealed tibial hypoplasia and the right foot displayed 8 digits with corresponding metatarsals and tarsals, whereas the left leg revealed 2 extra digits on the medial aspect of the foot with corresponding metatarsal and tarsal bones. Anatomical dissection of the right foot revealed that it was divided into halves consisting of 8 toes with corresponding metatarsals and tarsals, as well as tibial hypoplasia and absence of the great toe. Diplopodia associated with tibial hypoplasia and syndactyly can be treated surgically, and the present case report details the clinical, radiological, and anatomical elements of this rare deformity. [Copyright &y& Elsevier]

A 6-year-old girl is described with a unique, rare type of tibial hemimelia known as Carraro syndrome (OIMI 275230). There are only two previous reports of this condition in the literature. In our patient, the tibia anomaly was associated with other skeletal abnormalities, hemivertebra and tetralogy of Fallot. This association of malformations has not previously been reported. We conclude that this girl has either a variant of Carraro syndrome or a new syndrome. [ABSTRACT FROM AUTHOR]

Purpose: Ulna longitudinal dysplasia is an uncommon congenital anomaly that demonstrates a wide variety of clinical manifestations. The clinical manifestations and function of patients with Bayne type IV ulna longitudinal dysplasia have not been well characterized. The purpose of this study was to report the clinical features of type IV ulna longitudinal dysplasia and the extent to which this affects a patient’s ability to perform activities of daily living. Methods: The medical records of children diagnosed with ulna longitudinal dysplasia in our institution between 1960 and 2004 were reviewed. The children found to have ulna longitudinal dysplasia with radiohumeral synostosis (Bayne type IV ulna dysplasia) were studied. The laterality of the deformity, associated musculoskeletal and nonmusculoskeletal anomalies, and treatments were recorded. Patients were interviewed regarding their ability to perform activities of daily living. Results: One hundred twenty-five patients with 146 affected limbs were identified with ulna dysplasia. Seventeen limbs in 14 patients (12% of affected limbs) demonstrated radiohumeral synostosis (RHS). Three of 14 patients with RHS had bilateral involvement. The elbows were fixed in 20° to 90° of flexion. No elbows were positioned in full extension. Eleven of the 17 involved limbs with RHS had digital anomalies. Nine of the 17 limbs had surgical reconstruction. The majority of these procedures were performed on the hand. Conclusions: The elbow, forearm, wrist, and hand clinical findings associated with type IV ulna longitudinal dysplasia are variable. Surgical treatment usually focuses on correction of hand abnormalities. Many patients function satisfactorily and are able to perform daily activities without surgical intervention. Type of study/level of evidence: Diagnostic IV. [Copyright &y& Elsevier]

Fibular hemimelia is a congenital disorder characterized by partial or total absence of the fibula. The appearance of the affected limb can range from barely detectable to severe deformity. An affected extremity typically displays a valgus foot and ankle, shortening of the leg, anterior bowing of the tibia and knee, tarsal coalition, as well as radiographic absence of 1 to several lateral rays (). We encountered an adult patient who displayed fibular agenesis in combination with absence of the ipsilateral talus and cuboid. Because of the rarity of this deformity, we believed that it was important to describe her case despite the fact that, after evaluation and discussion of treatment options, the decision was made to continue to accommodate the deformity with an orthosis. [Copyright &y& Elsevier]

In rare instances, tarsal coalition leads to cavovarus foot deformity, although the pathologic mechanism leading to this deformity is not clear. This article reports a case of a 14-year-old boy presenting a severe cavovarus deformity of the right foot with talocalcaneal and calcaneonavicular coalitions, and a mild cavus deformity of the left foot with a single talocalcaneal coalition. Computed tomography and postoperative histologic analysis demonstrated a synostosis between talus and calcaneus and a fibrous calcaneonavicular coalition with partial ossification. Instrumented gait analysis revealed a limited range of ankle plantar flexion and increased external rotation of the ankle. Associated skeletal malformations including incomplete hemimelia of the forearm and scoliosis raised the possibility of a teratologic condition, but neurologic examination, spinal magnetic resonance imaging, and nerve conduction velocities were normal. The progressive ossification of combined coalitions during growth of the foot may have been one factor leading to this complex foot deformity. The fine-wire electromyogram showed normal tibialis anterior and posterior muscle activity. Small soft tissue tears in the sinus tarsi may have led to a mild reflexive increase of the muscle tone and tendon shortening, which pulled the forefoot into adduction and the heel into varus, and raised the medial arch. Mechanical alterations of the ankle appear secondary to the heel varus and to the progressive deformity of the talus. Three-dimensional computed tomography reconstruction and gait analysis appeared to be helpful additional parameters to understanding the pathomechanics of this complex foot deformity and for preoperative planning of triple arthrodesis. [Copyright &y& Elsevier]

Background. Fibular hemimelia Achterman-Kalamchi type II is a rare congenital deficiency and it may be associated with other deformities. Treatment includes amputation or leg lengthening. There are many studies that document the success of both procedures. The purpose of our study is to present the results of treatment by limb lengthening patients with this malformation. Methods. This review of 21 patients lengthened with an external fixator. It is based on the X-Ray and clinical data from The Shriners Hospital for Children, Mexico City Unit from January 1990 to December 2002. Six patients were excluded from the study: two because of complications from a previous surgery in another hospital, one patient was initially treated with prosthesis and three patients because of shortening and severe ankle deformities. We included fifteen patients with fibular hemimelia Kalamchi type II, 10 boys and 5 girls (15 limbs affected: 8 right and 7 left) with a mean age of 8.5 years at surgery (range 5.2 - 12.10). The mean leg length discrepancy before operation was 6.7 cm (range 4.2-13 cm) and the mean lengthening achieved was 5.9 cm (range 4-8). We utilized monolateral type fixator in 13 patients: on the tibia (10 cases) and on the femur (3 cases). One patient was lengthened with an anular fixator in the tibia, and one with three different settings: an orthofix prior to a Wagner and an Ilizarov type. Results. The results found were tibial angular deformities in four patients (9°-20°), procurvatum in 3 patients (23°-40°), valgus deformity at the ankle in 6 patients (20°-30°). There was one non union that required bone graft, 3 patients developed severe contractures at the ankle and knee joint that required muscle lengthening procedures. We concluded that satisfactory results can be achieved in lengthening of type II fibular hemimelia and that amputation should be considered in severe discrepancy and deformity of the affected limb. [ABSTRACT FROM AUTHOR]

The association of diplopodia and tibial hemimelia is uncommon. We report the case of a young girl, 5.2 years old with diagnosis of congenital bilateral diplopodia associated to bilateral tibial hemimelia. She was underwent to surgical amputation of the supernumerary structures followed by posteromedial release in a single step in the right foot; seven months later, in a single step too, the same procedures was performed in the left foot. This treatment offered results that we have considered satisfactory; since they have modified in a substantial way the image of the patient; allowing her return to activities without any restrictions, making a plantigrade and bipedal gait and used a normal footwear and with the satisfaction of the parents. The functional and aesthetic results are presented after the surgical management of the bilateral dipiopodia. [ABSTRACT FROM AUTHOR]