Systematic radiographic evaluation of tibial hemimelia with orthopedic implications

Bilateral Calcaneus Transfers for the Treatment of Congenital Tibial Deficiencies: A Novel Surgical Technique and Case Report

Tibial deficiency (also known as tibial hemimelia) is a rare condition with variable presentation. A 2-month-old patient presented with absent bilateral tibias. When the patient was 1 year, a novel reconstructive surgery was done. A bilateral fibular resection with pedicled calcaneus transfer was done, allowing for transfer of the calcaneus along with the overlying glabrous skin and soft tissues to the end of the femur. The patient was permitted to weight-bear after the 4-week postoperative follow-up. At the six-month follow-up, the patient was able to pull to stand and walk with assistance without any reports of pain.

Congenital Abnormalities in the Infant of a Diabetic Mother

Diabetes mellitus is among the most common chronic diseases worldwide. Infants of diabetic mothers are at increased risk of having congenital abnormalities. Tremendous progress has been achieved in the pregnancy care of diabetic women; however, the risk of birth defects associated with maternal diabetes still exists. These anomalies might arise in many organs and systems of the developing fetus. Many mechanisms have been implicated in the teratogenicity of maternal diabetes and it is critical to achieve good glycemic control before conception in women with diabetes. Neonatal clinicians must be able to identify patients at risk and recognize the signs of diabetic embryopathy. This article presents a review of congenital anomalies associated with maternal diabetes.

Deformity Reconstruction Surgery for Tibial Hemimelia

Tibial hemimelia is a rare congenital deficiency with a wide spectrum of pathology and deformity. This paper aims to give a comprehensive review of tibial hemimelia, with a concise summary of the history, pathology, and clinical findings of tibial hemimelia, while providing treatment recommendations and a review of the current literature. Classifications and surgical treatments are discussed, including amputation, limb reconstruction, and lengthening. Type-specific treatments are also discussed, including staged distraction correction of joint contractures of knee and ankle, Weber patelloplasty, fibular centralization, knee and ankle arthrodesis, implantable articulated distractors, and the role of femoral shortening. Amputation is a simpler and easier solution for many patients; however, reconstruction options continue to evolve, improve, and provide better functional outcomes in many cases. Factors favoring surgical reconstruction include the presence of a knee joint/proximal tibia, and the presence of a patella and quadriceps mechanism.

Usual Presentation Has Odds: Unilateral Tibial Hemimelia in One of Dizygotic Twins

Tibial hemimelia is a relatively rare congenital tibial longitudinal deficiency (approximately 1 per 1 million live births), unilateral or bilateral, with a relatively intact fibula. Hemimelia results from a disruption of the lower limb developmental field during embryogenesis due to slow or even abort of chondrification process, which results in leg length discrepancy. Affected leg commonly appears short and deformed with knee, ankle, and foot involvement. It may present with a variety of associated anomalies. Surgical treatment varies according to the type and degree of deformity, and reconstructive interventions are still limited. Reported cases of tibial hemimelia are very infrequent, especially tibial hemimelia in twins. Usually, the cases were in single embryo or less frequently in one of the monozygotic twins, but no reported cases regarding tibial hemimelia in one of the dizygotic twins as this article reports.

A High Prevalence Rate of Tibia Hemimelia in a Subregion of West Azarbaijan, Iran

From 1995 to 2017 an abnormally high number of tibia hemimelia (TH) patients from the Maku subregion in the West Azarbaijan province of Iran were referred to our orthopedic department for treatment. Regarding the occurrence of TH in many families in a restricted region and negative results of available genetic tests, we hypothesized that a founder mutation etiology that is different from previous known genetic disorders might produce the trait of TH in our patients. Through a retrospective study, we collected demographic data including date of birth, patients and parents place of birth, sex, type of TH, presence of other musculoskeletal anomalies, and treatment from the patients who were referred to our department. We obtained a blood sample for genetic studies. We carried out genetic studies in cytogenetics and molecular levels on a patient with familial TH. The prevalence of TH in the Maku subregion of West Azarbaijan was 149.5 (95% confidence interval [CI]: 68.4-283.8) per 1 million live birth. The patients did not fit with any known syndromes with TH. Genetic evaluations of a patient with familial history of TH in this case series exhibited no detectable change in both cytogenetic and molecular levels. There was an obvious increased prevalence rate of TH in this province and particularly in the Maku subregion. The cytogenetic locations for known syndromic TH are not responsible for the observed anomalies in our patients. Our next step for detecting possible genetic mutations in our patients would be mutation analysis via very high-resolution whole genomic sequencing in more patients or genetic linkage study.