Severe congenital malformation of the leg – reconstruction instead of amputation

In Switzerland, it is not uncommon for a severe malformation of this kind, such as this tibial aplasia (malformation of the tibia), to be considered grounds for amputating the limb. State-of-the-art surgical procedures do, however, enable the limb to be «saved».

In this case, the tibia is missing except for a small part at the knee joint, but by and large the fibula has developed normally. One problem encountered in the case of this young girl was, however, that her foot was misaligned at a 90-degree angle. After opting to reconstruct the limb following discussions with the child and her parents, we initially implanted an external fixator (Taylor Spatial Frame). Over the next three months, we distracted (stretched) the soft tissue whilst simultaneously aligning the foot in the correct position using computer-assisted technology.

During a further operation, the fixator was removed and the fibula was transferred to the location of the tibia. Thanks to the previous stretching procedure, the fibula only needed to be shortened a little. This meant that any loss of length was almost entirely avoided. The young girl is now able to walk with a small orthosis, but the leg will most certainly need to be lengthened once again in the future.

The initial situation is extremely complicated. The patient’s leg and foot are severely deformed and shortened.
Schwere Tibiaaplasie Röntgenbild
Rekonstruktion einer Tibiaaplasie mit äusserem Fixateur (Taylor Spatial Frame)
The soft tissue is distracted using a Taylor Spatial Frame until the foot is corrected and there is enough space for the fibula to be transferred to the area of the missing tibia.
Röntgenbild nach Behandlung mit Taylor Spatial Frame Tibiaaplasie
The fibula is healing very well, is increasing significantly in circumference due to the pressure applied when walking and will ultimately be used as a tibia.

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