Limb Salvage in Tibial Hemimelia
Perajit Eamsobhana MD*, Kamolporn Kaewpornsawan MD*
Affiliation : * Department of Orthopaedic Surgery, Faculty of Medicine, Siriraj Hospital, Bangkok, Thailand
Objective : To study the results of treatment of tibial hemimelia with limb salvage procedure in term of patient satisfaction,
clinical results and complications.
Material and Method: From 1993 to 2007 the authors treated six cases of tibial hemimelia with limb salvage procedures.
Three legs of type Ia and four legs of type IV tibial hemimelia classified by Jones classification. The age at the operation ranged
from 2 to 11 years. For type Ia cases, the Brown procedure, foot centralization and ilizarov lengthening of the fibula were used
to correct limb length discrepancy. For type IV, the foot centralization, soft tissue release and ilizarov lengthening were used
to correct limb length discrepancy. The follow-up range from 4 to 10 years.
Results : In two patients with type Ia, one patient could bear weight without gait aids, the other walked with orthosis and
axillary crutch because this patient had bilateral Ia type and knee instability with progressive flexion contracture due to
weakness of the quadriceps muscle. All patients with type IV can walk independently without gait aids. Three patients were
performed limb lengthening. One case was fibular lengthening following Brown procedure in Ia type. Two cases were tibial
lengthening in type IV. The mean lengthening was 5.1 cm. Mean lengthening index was 2.4. Satisfactory functional and
cosmetic results were achieved in all patients with partial deficiency, whereas in patients with completely deficiency of the
limbs, none of the 3 knees treated by fibular transfer achieved a satisfactory functional result because of insufficient quadriceps
strength, progressive knee flexion contracture and persistent ligamentous instability. Nevertheless, in these 3 legs, all patients
were ultimately able to withstand weight bearing.
Conclusion : Patients and families were satisfied even though patients must have multiple surgery to correct deformities of the
foot and the knee joint, as well as leg-length discrepancy and also a prolong treatment time. Limb salvage procedure in tibial
hemimelia is appropriate in Thai culture because patients can weight with bare feet in the house and have sensation in the feet.
Keywords : Tibial hemimelia, Brown procedure, Foot centralization, Limb length discrepancy
