MANAGEMENT OF FIBULAR HEMIMELIAAMPUTATION OR LIMB LENGTHENINGD. Naudie, BSc, Medical Student; R. C. Hamdy, MD, FRCS C, Assistant Professor of Orthopaedic Surgery; F. Fassier, MD, FRCS C, Associate Professor of Orthopaedic Surgery; B. Morin, MD, FRCS C, Associate Professor of Orthopaedic Surgery, Assistant Chief of Staff; and M. Duhaime, MD, FRCS C, Professor of Orthopaedic Surgery, Chief of StaffShriners Hospital for Crippled Children, 1529 Avenue Cedar, Montreal, Quebec, Canada H3G 1A6. Correspondence should be sent to Dr R. C. Hamdy. We reviewed retrospectively 22 patients (23 limb segments) with fibular hemimelia treated by amputation or limb lengthening to evaluate these methods of treatment. There were 12 boys and 10 girls, all with associated anomalies in the lower limbs. Twelve patients (13 limb segments) had early amputation and prosthetic fitting and ten had tibial lengthening using the Ilizarov technique. At the latest follow-up, the twelve patients who had amputation were functioning well and had few complications. The ten patients who had lengthening had suffered numerous complications, and all had needed either further corrective surgery or to wear braces or shoe-raises. Two of the ten lengthened limbs required late amputation for poor function or cosmesis. There were fewer hospital admissions, clinic visits, and periods of absence from school in the amputation group. Our findings suggest that amputation is a more effective method of management than limb-lengthening in severe fibular hemimelia. The Ilizarov method is an attractive alternative for selected patients, but its exact role is not yet established. One problem is that families often have unrealistic expectations of the surgical and prosthetic technology available and may refuse amputation when this has been recommended.
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