Orthopedics - Oleksa A.P. 2006

Congenital and acquired deformities of the lower limb
Congenital deformities of the lower leg
Congenital absence of the fibula

Congenital Deformities of the lower leg are caused by Developmental anomalies of its bones due to aplasia or hypoplasia. In clinical practice, there are cases of absence of the Fibula, less frequently the Tibia, bowing of both lower leg bones, congenital defects, and pseudarthrosis of the tibia, or even of both bones.

Fibular aplasia can be complete (Fig. 176) or partial. Sometimes it may be associated with other developmental anomalies (absence of the cruciate ligaments or meniscus of the knee joint, absence of the Patella, hypoplasia of the bone processes, FOOT bones, etc.). Volkmann's deformity is well known, consisting of Congenital absence of the fibula and valgus deformity of the lower leg and foot (Fig. 177). Partial fibular aplasia was described by Mastrogastino under the name acromegalia monosegmentaria decperone.

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Fig. 176. Congenital absence of the fibula (a) and its rudiment (b).

Fig. 177. Volkmann's deformity: absence of the fibula, thickening and bowing of the tibia, absence of the talus and other BONES OF THE foot (Boychev B., 1968).

These defects are caused by disturbances in the primary anlage and in the Cytology/cytology/16.html">Early stages of fetal development.

Complete or partial absence of the fibula clinically manifests as valgus deviation of the lower leg and foot, along with some shortening. The peroneal tendons are displaced anteriorly, and the Achilles tendon is displaced laterally.

The Diagnosis is confirmed by Palpation and radiography.

Treatment begins once the diagnosis is established. Children are prescribed a corrective splint, which is changed as they grow, and Muscle massage is performed. Once the child begins to walk, the valgus deviation of the foot and lower leg increases. To prevent this, children are prescribed an orthopedic brace and orthopedic shoes. However, because the child grows rapidly, this is very difficult to implement in practice.

As early as three years of age, due to shortening of the lower leg and valgus deviation of the foot, ankle arthrodesis (according to Putti) is performed, aligning the foot in the correct position relative to the axis of the lower leg with slight equinus to compensate for limb shortening.

If the lateral malleolus (malleolus lateralis) is absent but the valgus deviation of the foot is minor, an osteoplastic surgery is performed: a lateral support for the foot is created using a bone graft, which is fixed to the tibia at two points—in the area of the distal syndesmosis projection and 2–3 cm above it. For this graft to fuse with the tibia, it must be tightly fitted into a properly prepared bed.

During the period of graft fusion and remodeling, a plaster cast boot is applied, which is changed every three to four weeks.

The arthrodesis technique proposed by Albee, which involves driving a bone graft into the tibia, can be used in cases of severe deformity. V. A. Shturm drove a bone wedge into the talus through the calcaneus, thereby achieving greater Stability of the foot.

In cases of significant limb shortening that cannot be compensated for by the equinus position of the foot, and especially for cosmetic reasons and to prevent secondary changes (pelvic tilt, spinal curvature), it is advisable to perform timely limb segment lengthening using the Ilizarov method (osteotomy with apparatus-assisted distraction). The patient must use orthopedic footwear.

In partial aplasia, the fibular diaphysis may be absent. To prevent secondary deformities, such as valgus deviation of the lower leg and foot, patients are recommended corrective night splints and arch Supports. At 4–5 years of age, synostosis of the distal fibular segment to the tibia is performed, provided the ankle mortise is normally preserved. If a planovalgus foot deformity has developed, corrective osteotomy of the valgus-deviated tibia is performed, combined with its lengthening if necessary.