Module 7, Pediatric Orthopaedist Level

This 1 year and 3 month old female was the product of a normal vaginal delivery at 38 weeks gestation without complications. She was one of twins, and her sister was healthy, without deformity. Soon after birth the infant was noted to have a severe deformity involving the right leg and right foot. Examination of the right lower extremity demonstrates shortening of the right thigh with a 10 degree flexion contracture present in the knee. The knee is noted to be in valgus. The foot is held in a position of severe equinovalgus with absence of the lateral two rays. The patient initially underwent a corrective tibial osteotomy and Boyd amputation of right foot. The postoperative course was complicated by the development of a nonunion at the osteotomy site.

Question 7A

These osteotomies do not heal and this should now be amputated at the non-union site.

Question 7B

If this non-union heals recurrent angulation is likely.

Question 7C

Concurrent anomalies of the ipsilateral femur common with congenital shortening is seen in up to 60% of patients.

Question 7D

In Congenital shortness of the fibula, Type IB - There is partial absence of the fibula (30-50%) with the distal remaining portion unable to function in ankle support.

Question 7E

Children who have limb lengthenings have a better outcome as a result of the treatment than matched children who have amputations.