Antenatal sonographic diagnosis of isolated bilateral fibular hemimelia

Prenatal diagnosis of type 1 fibular hemimelia

Fibular hemimelia (FH) is a congenital longitudinal limb deficiency characterized by complete or partial absence of the fibula. Typically, it has been diagnosed at birth, when the neonate is seen to have lower limb shortening and a foot with missing toes. Although it is the most frequent lower limb deficiency anomaly, there are few published reports of prenatally diagnosed cases. Most of these published cases have involved the complete absence of the fibula, which is relatively easy to diagnose with antenatal ultrasound. In our opinion, our case is the first case of unilateral partial absence of the fibula detected using prenatal ultrasound imaging. Herein, we report a FH case associated with foot equinovalgus, and absence of the fourth and fifth foot rays diagnosed at 24 weeks' gestation. The anomaly was confirmed after birth by X-ray, and conservative orthopedic management was chosen. Our case shows that partial limb defects can also be detected by prenatal ultrasound imaging.

Management of congenital femoral deficiency

Abnormalities that affect the developing human limb range from subtle differences that are of no functional or cosmetic consequence, to complete absence of all limbs. Advances in non-invasive imaging have improved antenatal detection of these conditions and has broadened the options available to prospective parents. This paper considers congenital femoral deficiency and includes an overview of limb bud development and the mechanisms involved in normal growth. The use of ultrasound in antenatal screening and the clinical and radiological features in childhood will be discussed in addition to management including surgical reconstruction and prosthetic use. This should be one component of a multidisciplinary approach to provide the parents of an affected child with balanced information on functional prognosis, management choices and implications for future pregnancies.

Prenatal diagnosis of a congenital postaxial longitudinal limb defect: a case report

Introduction. Although congenital longitudinal fibular deficiency is one of the most common long bone deficiencies, there are few published cases of its prenatal diagnosis. Case report. A right longitudinal deficiency of the fibula associated with tibial shortening, foot equinovalgus, and absence of the fourth and fifth foot rays diagnosed at 22 weeks gestation is described. Sequential ultrasonographic surveillance was performed without obstetric complications. The anomaly was confirmed after birth, and conservative orthopaedic management was decided. Conclusion. Though rarely seen, postaxial longitudinal limb defect may be detected by ultrasound. The correct approach can only be decided after birth, when the functional impact of the anomaly can be fully evaluated.

Amputation of an ectopic partially formed foot attached to the ankle in a case of fibular deficiency

A rare case of an ectopic partially formed foot attached to the ankle and associated with fibular deficiency and scoliosis due to congenital hemivertebra is reported. The ectopic partially formed foot was amputated and the child was given a below-knee caliper to prevent further deformity of the foot.

Bilateral fibular hemimelia with recto-vestibular fistula associated with amniotic bands

Fibular Hemimelia is a rare congenital disorder of deficiency to complete absence of fibula. It has been associated with post axial skeletal anomalies like shortening of femur, absence of lateral rays of foot and syndactyle, polydactyle etc. We report this case because of associated amniotic constriction bands over both the forearm, suggesting amniotic bands may be one of the causal factors of Fibular Hemimelia due to insult to the growing limb bud.

Syndromes with focal femoral deficiency: strengths and weaknesses of prenatal sonography

OBJECTIVE

To further characterize the prenatal diagnosis of proximal focal femoral deficiency and to contrast this entity with a variety of other "syndromes" in which the femur may be deficient.

METHODS

We report 2 cases of proximal focal femoral deficiency and a case of femoral-facial syndrome.

RESULTS

A series of 3 women whose fetuses had deficiency of 1 or both femurs were carefully analyzed for severity and for similarities and differences with other syndromes in which the femur may be deficient, as well as syndromes showing global skeletal abnormalities.

CONCLUSIONS

Prenatal sonography is a valuable tool both for detecting cases of proximal focal femoral deficiency, separating them from syndromes showing global skeletal abnormalities, and for stratifying them according to severity.