Managements of Type 2 Tibial Hemimelia; Short Review on Treatment of Tibial Defects and The Results of Four Patient Treated Using a Modified Brown Procedure
Iraqi Postgraduate Medical Journal,
2014, Volume 13, Issue 4, Pages 454-465
Tibial hemimelia is a very rare deformity and problematic syndrome usually associated with variable visceral and skeletal deformities. The treatment is always difficult and challenging. Amputation was the preferred treatment option specially in complete tibial absence, however, a conservative management sometimes used in other types of the deformity or in cases of amputation refusal.
To review the methods of management of chronic tibial defects and to study the results of operative treatment of 4 patients with type ii congenital tibial hemimelia.
PATIENT AND METHOD:
All along thirty-two months period and after a proper clinical and radiological assessment we treated four male children with a mean age of 8.5 years who were all right sided type 2 tibial hemimelia according to Jones and Kalamchi with absence of the distal tibia. Treatment consisted of proximal fibula transfer to the lower end of the tibial stump (brown's operation) followed by Syme's amputation and prosthetic fitting.
In all cases the transferred fibular shaft to the distal end of the tibial remnant was united within two to three months. The fibulae grew in length and the size to be tibialized and the leg increased in length as we preserved the distal fibular epiphysis.
The results were acceptable as we saved and reconstructed the limb, we gained an acceptable knee function and stable prosthetic fitting that aided proper rehabilitation.
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