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Fibular Transfer for Congenital Absence of the Tibia: A Reassessment

Six children (nine limbs) underwent fibular centralization for complete paraxial tibial hemimelia. The preoperative, intraoperative, and postoperative criteria as described by Brown (J Bone Joint Surg |Am| 1965;47:695–704) were strictly met. At initial postoperative evaluation, three limbs had active knee extension, and live limbs had minimal flexion contractures. However, at final follow-up, 20–123 months later, all knees had ligamentous instability and poor active range of motion: eight had significant flexion contractures. All were classified as poor results. Based on this series and other reports, it is recommended that knee disarticulation instead of fibular centralization be performed for complete paraxial tibial hemimelia, preferably within the first year of life.