The Experts below are selected from a list of 360 Experts worldwide ranked by ideXlab platform
Dror Paley - One of the best experts on this subject based on the ideXlab platform.
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deformity reconstruction surgery for tibial Hemimelia
Children today, 2021Co-Authors: David Y Chong, Dror PaleyAbstract:Tibial Hemimelia is a rare congenital deficiency with a wide spectrum of pathology and deformity. This paper aims to give a comprehensive review of tibial Hemimelia, with a concise summary of the history, pathology, and clinical findings of tibial Hemimelia, while providing treatment recommendations and a review of the current literature. Classifications and surgical treatments are discussed, including amputation, limb reconstruction, and lengthening. Type-specific treatments are also discussed, including staged distraction correction of joint contractures of knee and ankle, Weber patelloplasty, fibular centralization, knee and ankle arthrodesis, implantable articulated distractors, and the role of femoral shortening. Amputation is a simpler and easier solution for many patients; however, reconstruction options continue to evolve, improve, and provide better functional outcomes in many cases. Factors favoring surgical reconstruction include the presence of a knee joint/proximal tibia, and the presence of a patella and quadriceps mechanism.
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Surgical reconstruction for fibular Hemimelia
Journal of Children's Orthopaedics, 2016Co-Authors: Dror PaleyAbstract:Fibular Hemimelia presents with foot deformity and leg length discrepancy. Previous classifications have focused on the degree of fibular deficiency rather than the type of foot deformity. Published methods of surgical reconstruction have often failed due to residual or recurrent foot deformity. The purpose of this report is to introduce new classification and reconstruction methods. The Paley SHORDT procedure is used to stabilize the ankle when there is a hypoplastic distal fibula with a dynamic valgus deformity. It involves shortening and realignment of the distal tibia relative to the fibula. In contrast, the Paley SUPERankle procedure is used when there is a fixed equinovalgus foot deformity. The SUPERankle uses a supramalleolar shortening-realignment osteotomy and/or subtalar osteotomies with anlage resection. Due to the bony instead of soft tissue correction of deformity, residual or recurrent deformity is prevented. Weakening of gastro-soleus and peroneal muscles is avoided by shortening of the tibia instead of tendon lengthening. The limitation of ankle motion is related to ankle dysplasia rather than surgery or lengthening. A plantigrade-stable foot and ankle leads to an excellent functional result comparable or better than a Syme’s amputation with prosthetic fitting. Serial lengthening procedures combined with the SHORDT or SUPERankle reconstruction lead to limb length equalization with a plantigrade, painless, functional foot.
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Tibial Hemimelia: new classification and reconstructive options
Journal of Children's Orthopaedics, 2016Co-Authors: Dror PaleyAbstract:Tibial Hemimelia is a rare congenital lower limb deficiency presenting with a wide spectrum of associated congenital anomalies, deficiencies and duplications. Reconstructive options have been limited, and the gold standard for treatment has remained amputation with prosthetic fitting. There is now a better understanding of the genetics, etiology and pathoanatomy of tibial Hemimelia. Armed with this knowledge, I present here a new classification to guide treatment and prognosis and then discuss new treatment strategies and techniques for limb reconstruction based on this new classification scheme.
K W Cheung - One of the best experts on this subject based on the ideXlab platform.
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severe progressive deformities after limb lengthening in type ii fibular Hemimelia
Journal of Bone and Joint Surgery-british Volume, 1998Co-Authors: Jack C Y Cheng, K W CheungAbstract:Until recently the accepted treatment of choice for severe type-II fibular Hemimelia has been Syme's or Boyd's amputation. The alternative of distraction lengthening using the Ilizarov technique is now available. We report three patients (four limbs) with type-II fibular Hemimelia who were treated by the Ilizarov technique and followed up for two to six years. Severe progressive procurvatum and valgus deformity of the tibia and valgus deformity and lateral subluxation of the ankle were found in all four limbs. Multiple additional soft-tissue and bony surgery was necessary. In view of these problems we feel that reappraisal of the indications for lengthening in type-II fibular Hemimelia is necessary.
Amin Abdel Razek Youssef Ahmed - One of the best experts on this subject based on the ideXlab platform.
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Ankle reconstruction in type II fibular Hemimelia
Strategies in Trauma and Limb Reconstruction, 2012Co-Authors: Hazem Mossad El-tayeby, Amin Abdel Razek Youssef AhmedAbstract:Ankle reconstruction prior to limb lengthening for was performed in 13 patients with fibular Hemimelia with complete radiological absence of the fibula (type II). There were different degrees of absence of metatarsal rays. The hindfoot deformity was a heel valgus in 12 patients and equinovarus in 1 patient. The patients’ ages ranged from 9 to 26 months. Excision of the fibular anlage was performed with lateral subtalar and ankle soft tissue releases to restore the ankle and subtalar joint relationships. In all cases, the fibular anlage ended distally in a cartilaginous lateral malleolar remnant that was fused to the talus in two patients. This fibular remnant was advanced distally and fixed to the tibia with 2 Kirschner wires to recreate an ankle mortise. The period of follow-up ranged from 12 to 38 months. All patients had a stable ankle without tendency to valgus deformity or subluxation. The ankle range of movement was a mean of 27.3° plantarflexion (25–30) and 18° dorsiflexion (15–20). Reconstruction of the ankle in type II fibular Hemimelia using advancement of the cartilaginous lateral malleolar remnant has produced encouraging results in the short-term but longer follow-up is needed.
Jack C Y Cheng - One of the best experts on this subject based on the ideXlab platform.
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severe progressive deformities after limb lengthening in type ii fibular Hemimelia
Journal of Bone and Joint Surgery-british Volume, 1998Co-Authors: Jack C Y Cheng, K W CheungAbstract:Until recently the accepted treatment of choice for severe type-II fibular Hemimelia has been Syme's or Boyd's amputation. The alternative of distraction lengthening using the Ilizarov technique is now available. We report three patients (four limbs) with type-II fibular Hemimelia who were treated by the Ilizarov technique and followed up for two to six years. Severe progressive procurvatum and valgus deformity of the tibia and valgus deformity and lateral subluxation of the ankle were found in all four limbs. Multiple additional soft-tissue and bony surgery was necessary. In view of these problems we feel that reappraisal of the indications for lengthening in type-II fibular Hemimelia is necessary.
J Ritter - One of the best experts on this subject based on the ideXlab platform.
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prenatal diagnosis of unilateral tibial Hemimelia
Ultrasound in Obstetrics & Gynecology, 1996Co-Authors: M Dreyfus, J J Baldauf, E Rigaut, J M Clavert, B Gasser, J RitterAbstract:We describe a case of unilateral tibial agenesis which was initially observed at 21 weeks' gestation. Unlike bilateral tibial Hemimelia syndrome, a rare autosomal dominant condition, unilateral tibial agenesis, which accounts for about three-quarters of all newborns with this condition, has not previously been described. This case could have been a sporadic abnormality but, in view of the association with other observations (distal bifurcation of the femur, club foot), could be considered as an autosomal recessive inherited condition with variable penetrance. Ultrasonographic features and the genetic prognosis are discussed. Copyright © 1996 International Society of Ultrasound in Obstetrics and Gynecology