Tibial Hemimelia Treatment

Dr. Ratnav Ratan offers consultations and treatment on tibial hemimelia conditions in growing children. He is a consulting orthopedist in Gurgaon with varied experience in pediatric orthopedics and treating sports injuries.

A patient with an absent or a shortened tibia with an unaffected fibula is said to have tibial hemimelia. In cases of subtle deformities, the patient may have a duplication of the great toe. Tibial hemimelia refers to deformities in the lower extremities and malformations in the foot.

The line of treatment of tibial hemimelia requires some critical decision-making regarding amputation vs reconstruction of the limb. The other factors that have to be taken into account are the possibility of quadriceps functioning regarding extension of the knee joint.

What is tibial hemimelia?

Tibial hemimelia is a rare deformity and occurs in one out of one million live births. It is detected through ultrasonography performed during or after the fourth month of pregnancy.

Tibial hemimelia is associated with the following syndromes viz.

  • Werner’s syndrome
  • Tibial hemimelia-polysyndactyly-triphalangeal thumb syndrome (THPTTS)
  • CHARGE syndrome

Characteristics of Tibial hemimelia

  • It can be bilateral or unilateral.
  • Nearly 30% of the tibial hemimelia cases are bilateral
  • Nearly 72% of the unilateral tibial hemimelia cases have the right side affected
  • Tibial hemimelia can be present with congenital femoral deficiency or any other congenital deficiency.

Variations in deficiency in tibial hemimelia conditions

  • Congenitally short tibia with relative fibular overgrowth
  • Complete absence of the tibia

How to identify tibial hemimelia from fibular hemimelia

In cases of tibial hemimelia, the foot and the ankle are always pointing inwards i.e. varus, while in fibular hemimelia, the foot and the ankle point outwards, i.e., valgus.

In fibular hemimelia cases, this deficiency progresses from ankle to the knee, while in fibular hemimelia, the progression takes place from knee to ankle; this is the main defining feature of fibular hemimelia from other similar conditions.

Treatment of tibial hemimelia

The treatment approach of tibial hemimelia includes surgery, amputation, and orthotic treatment as recovery and restoring limbs’ mobility.

The orthopedic surgeon focuses on achieving a functional limb equal to the normal limb when the patient attains full growth. The patient needs to have a functional, flat, stable, and flexible foot. Hence, treating tibial hemimelia is customized as per the patient’s condition in consultation with a team of multidisciplinary experts. All the associated anomalies and deformities should be screened and evaluated before proceeding with the surgical procedure.

Most patients diagnosed with tibial hemimelia need to undergo a surgical procedure to correct their deformity. Also, they may need to wear customized splints or braces for mobility.

The extent or degree of quadriceps mechanism in these patients determines whether the limb with tibial hemimelia should be salvaged or amputated. In most cases, projected limb length discrepancy along with reconstructive treatment has led to average results. However, modern limb lengthening procedures have had desired results with some treatable complications.

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