Reconstructive surgery for fibular deficiency O. E. SHATILOV, A. V. ROZKOV and T. V. CHEMINOVA

Three types of fibular deficiency are described which determine the nature of the surgery and prosthesis required. The surgical management of 50 patients who had a total of 103 operations is described. Introduction The seriousness of the pathology, variety of clinical manifestations, and the involvement of several limbs makes the medical rehabilitation of children with longitudinal congenital deficiencies very difficult. It is necessary to apply the whole complex of modern methods of surgical treatment and prosthetics and orthotics, in order to solve the problem. Treatment must eliminate the deformity and shortening, improve the weightbearing and motor function of the limb and allow the fitment of an improved prosthesis. During the last 30 years the authors have followed up 213 children, 50 of whom underwent surgical reconstruction. Fibular deficiency Absence or deformity of the fibula, the most common longitudinal lower limb deficiency, was first described by Göller (a German scientist) in 1967 (Coventry and Johnson, 1962). Clinically this deficiency presents with shortening, malformation and deformity of the foot. In the majority of cases there is angulation of the distal tibia with convexity forwards and medial rotation. The foot is in equinovalgus and the ankle is subluxed laterally. The fourth and fifth metatarsals and toes are often absent. The talus and calcaneus are often deformed and may be fused. The tibial deformity and foot displacement (sometimes as far as the middle third of the leg) are caused by the presence of a fibro-cartilaginous cord or anläge representing the fibula. Haudek in 1896 was the first to describe this cord (Thompson et al., 1957), and Karchinov (1963), Karimova (1975) and Bedova (1981) studied its location, structure and influence on the deformity. In addition some children have a valgus deformity of the knee with a flexion contracture. Treatment Three types of fibular deficiency are Fig. 1. An example of a Group 1 deficiency. AH correspondence to be addressed to Dr. O. E. Shatilov, The Leningrad Scientific Research Institute of Prosthetics, Bestuzlevskaya 50, Leningrad 195067, USSR.