Bilateral fibular hemimelia type II

Case contributed by Dr Mahmoud Ibrahim Mekhaimar

Presentation

Lower limb length discrepancy and abnormal gait.

Patient Data

Age: 10 years
Gender: Male
CT

Lower limbs

  • incomplete fusion of the posterior neural arch of S1 vertebra
  • right coxa vara
  • abnormal remodelling of lower ends of both femori
  • complete absence of both fibulae
  • abnormal bone remodelling of the upper end of the right tibia
  • dysplastic both knee joints
  • left genu varus 
  • talipes calcaneovalgus of the left foot
  • oligodactyly and syndactyly of the right foot toes
  • horizontal sclerotic lines are seen within both femori, likely of previous intervention

Case Discussion

Fibular hemimelia is a congenital lower limb anomaly characterized by a partial or a complete absence of the fibula. Although rare in occurrence, it is the most common congenital absence of long bone of the extremities. 

Fibular hemimelia is usually obvious at birth with limb shortening and limb-length discrepancy. Syndactyly, oligodactyly or polydactyly may also be present. 

Different classification systems have been developed. One of them is Achterman-Kalamchi classification which depends on the morphology of the fibula 1:

  • type 1, the fibula is present but hypoplastic
  • type 2, it is completely absent

So, our case is classified as Achterman-Kalamchi type II.

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Case information

rID: 69581
Published: 15th Jul 2019
Last edited: 19th Aug 2019
Inclusion in quiz mode: Included
Institution: kasr al ainy medical school

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