Clinical, radiological and anatomical dissection findings in tibial hemimelia Jones type Ia treated with knee disarticulation
Bülent Dağlar1, Önder Murat Delialioğlu1, Mustafa Ağar1, Bülent Adil Taşbaş1, Kenan Bayrakcı1, Selçuk Sürücü2, Uğur Günel1
1Ankara Numune Eğitim ve Araştırma Hastanesi 4. Ortopedi ve Travmatoloji Kliniği
2Hacettepe Üniversitesi Tıp Fakültesi Anatomi Anabilim Dalı
Keywords: Amputation; child; ectromelia; magnetic resonance imaging; tibia/abnormalities/surgery; ultrasonography.
A nine-month old male infant underwent bilateral knee disarticulation for bilateral tibial hemimelia of Jones type Ia. The disarticulation materials were further examined by anatomical dissection and magnetic resonance imaging. The classification of hemimelia was made as Jones type Ia upon detection of no tibial component on ultrasonographic examination. Since there was no quadriceps function, bilateral knee disarticulation was performed. Magnetic resonance imaging of the amputation material was not very helpful in identifying soft tissue anomalies possibly due to small size of surgical specimens. However, small bony structures, which were mostly cartilaginous, were well visualized. During anatomic dissection, nearly all major musculotendinous units were identified, with some having anomalous insertions because of ray deficiencies. Strong fibrous bands were found to tether the foot remnant to the fibula and there were no cartilaginous or fibrous tibial remnants. At the end of the second postoperative year, the patient could walk with his prostheses without support, could run, and climb stairs with support.