The Morbid Anatomy of Congenital Deficiency of the Tibia and its Relevance to Treatment

Abstract

Two specimens obtained from a 5-month-old boy with bilateral type 1a congenital tibial deficiency were dissected to describe their morbid anatomy. Examination revealed a rigid equinovarus deformity, absence of a tibial remnant, an abnormal saddle-shaped talus, and several tarsal coalitions. Observation of the arterial pattern during surgery supported the previously reported finding that persistence of an immature arterial structure is inherent in this condition. Knowledge of potential structural anomalies is essential during the planning of an amputation or of a knee or an ankle reconstruction. Anatomic abnormalities may affect the design of soft-tissue flaps in an amputation and plantigrade positioning and foot biomechanics in reconstructive procedures.

Get full access to this article

View all access options for this article.

References

Brown

F.W.

Construction of a knee joint in congenital total absence of the tibia (paraxial hemimelia tibia): A preliminary report. J. Bone Joint Surg., 47A: 695–704, 1965.

Brown

F.W.

Pohnert

W.H.

Construction of a knee joint in meromelia tibia (congenital absence of the tibia). A 15-year follow-up study. Proceedings of the American Academy of Orthopedic Surgeons. J. Bone Joint Surg., 54A: 1333, 1972.

Cornah

M.S.

Dangerfield

P.H.

Reduplication of the femur. Report of a case. J. Bone Joint Surg., 56B: 744–745, 1974.

Garbarino

J.L.

Clancy

Harckem

H.T.

Steel

H.H.

Cowell

H.R.

Congenital diastasis of the inferior tibiofibular joint: A review of the literature and report of two cases. J. Pediatr. Orthop., 5: 225–228, 1985.

Hootnick

D.R.

Kevinsohn

E.M.

Randall

P.A.

Packard

D.S.

Jr.

Vascular dysgenesis associated with skeletal dysplasia of the lower limb. J. Bone Joint Surg., 62A: 1123–1129, 1980.

Jones

Barnes

Lloyd-Roberts

G.C.

Congenital aplasia and dysplasia of the tibia with intact fibula. Classification and management. J. Bone Joint Surg., 60B: 31–39, 1978.

Kalamchi

Dawe

R.V.

Congenital deficiency of the tibia. J. Bone Joint Surg., 67A: 581–584, 1985.

Karchinov

Congenital diplopodia with hypoplasia or aplasia of the tibia. A report of six cases. J. Bone Joint Surg., 55B: 604–611, 1973.

Matthews

W.E.

Mubarak

S.J.

Carroll

N.C.

Diastasis of the tibiofibular mortise, hypoplasia of the tibia, and clubfoot, in a neonate with cleft hand and cardiac anomalies. A case report. Clin. Orthop., 126: 216–219, 1977.

10.

Otto

A.W.

Monstorum sexcentorum descripto anatomica. In Sumptibus Ferdinandi Hirt. Breslau, 1841.

11.

Wehbé

M. A.

Weinstein

S.L.

Ponseti

I.V.

Tibial agenesis. J. Pediatr. Orthop., 1: 395–399, 1981.

12.

Williams

Wientroub

Getty

C.J. M.

Pincott

J.R.

Gordon

Fixsen

J.A.

Tibial dysplasia. A study of the anatomy. J. Bone Joint Surg., 65B: 157–159, 1983.

13.

Wolfgang

G.L.

Complex congenital anomalies of the lower extremities: Femoral bifurcation, tibial hemimelia, and diastasis of the ankle. Case report and review of the literature. J. Bone Joint Surg., 66A: 453–457, 1984.