Purpose: Management of ankle deformity and instability remains a challenge in patients with severe fibular hemimelia (FH). This study aims to evaluate the long-term effectiveness of lateral malleus reconstruction using the fibular anlage in correcting ankle malalignment and preventing the recurrence of deformity following leg lengthening. Methods: Ten patients (age: 3.3 years, 0.8–7.7) with a severe FH, equino-valgus foot deformity, ankle instability, and tibial bowing underwent tibia and ankle realignment and lateral malleolus reconstruction. Afterward, all patients underwent tibial lengthening, and the mean lengthening was 9.9 cm (5.0–16.5). Foot and ankle alignment was evaluated clinically and radiographically before surgery, postoperatively, and at a follow-up (10.0 years, 9.2–11.7). Recurrences, additional procedures, and complications were analyzed. Quality of life was assessed using the Limb Deformity-Scoliosis Research Society (LD-SRS) questionnaire. Results: At the last follow-up, all patients present neutral heel position or slight valgus (three patients 5° and one patient 10°). No additional procedures were performed except medial malleus temporary epiphysiodesis in two patients. The foot was plantigrade in six patients, presented equinus 10° in two and 20° in two, due to equinus, supra-malleolar osteotomy was performed in three patients. Significant improvement of radiological alignment was found and maintained in all parameters. The mean LD-SRS score was 3.78 at follow-up. Conclusion: Lateral malleolus reconstruction provided good clinical, radiological, and functional outcomes. Due to the tendency for recurrence, additional procedures may be necessary. Level of Evidence: IV

Introduction: Patients with fibular hemimelia (FH) require multistage treatment, which often includes repeated and extensive limb lengthening procedures. One of the complications of leg lengthening is tibia fracture at the level of the regenerate, which poses an even greater risk in the absence of the fibula. Possible solutions include cast immobilization or prophylactic intramedullary stabilization; however, it may be associated with a risk of infection. Methods: All patients treated with tibial lengthening for fibular hemimelia at a single institution between 2014 and 2024 were included in the study. In total, 48 tibial lengthening procedures using circular external fixators were performed in 41 patients. After completion of lengthening and at externa fixator removal, prophylactic intramedullary nailing (Rush rods or Titanium Elastic Nails) was used in 24 cases, while a patellar tendon-bearing (PTB) cast was applied in 24 cases. Following nail implantation, antibacterial prophylaxis was administered for 10 days. The mean follow-up period from the time of external fixator removal was 56.6 months (range 18 to 109). Tibial lengthening parameters (achieved lengthening, External Fixator Index) and radiologic parameters of the regenerate (number of visible cortical walls and the Ru–Li classification) were evaluated. The prevalence of fractures, infections, unplanned reoperations, or complications during and after the lengthening process was analyzed. The data were compared between the nailing group versus non-nailng group. Results: The groups were comparable in terms of sex distribution, regenerate length, regenerate quality, and External Fixator Index. The group without prophylactic intramedullary nailing was significantly older (mean 11.5 y, range 2.4 to 18.0) compared with the prophylactic nailing group (mean 7.5 y, range 2.5 to 16.6), P =0.002. No fractures occurred in patients who underwent prophylactic intramedullary nailing, whereas 6 fractures (25%) occurred in patients without prophylactic nailing (4 within the first month, 1 after 4 mo, and one 6 mo after removal of the external fixator), P =0.0229. No infections was observed in either group. Conclusions: Prophylactic intramedullary nailing performed at external fixator removal significantly reduced the risk of fractures after completion of tibial lengthening in patients with fibular hemimelia. With the use of antibiotic prophylaxis, no infections were observed following intramedullary nailing. Level of Evidence: Level III.

Background/Objectives: Lower limb congenital deficiencies represent challenging disorders that require a complex strategy for limb reconstruction and lengthening procedures guided by the anatomical type and severity of the deformity. This review aims to summarize current treatment approaches in limb reconstruction and lengthening for patients with common congenital lower limb deficiencies, including fibular hemimelia, congenital femoral deficiency, and tibial hemimelia. Methods: A literature search was conducted using major databases, complemented by the senior author’s clinical experience and case series, to identify relevant studies and current procedures for the management of common congenital lower limb deficiencies, including limb reconstruction and lengthening techniques. Results: The various clinical presentation and classification systems of congenital lower limb deficiencies are presented, as well as up to date surgical techniques including limb reconstruction and lengthening. These approaches demonstrated effectiveness in congenital limb deficiencies management by facilitating joint stabilization and subsequent limb lengthening, leading to improved functional outcomes. However, significant challenges persist, including prolonged treatment duration and patient discomfort. Modern surgical approaches have significantly improved the outcomes of treatment for congenital limb deficiencies. However, the complexity of these clinical entities requires individualized treatment strategies. Conclusions: Successful management of congenital lower limb deficiencies relies on individualized, patient-specific treatment planning, incorporating preparatory surgical interventions and sequential limb lengthening procedures to maximize functional outcomes.

Background: Currently, there is a deficit of questionnaires available in Polish for as-sessing the quality of life of children with limb deformities. The LD-SRS questionnaire consists of 30 questions in 5 domains: function, experienced pain, patient's own ap-pearance, mental health and satisfaction with management, scored on a 1–5 scale, where higher scores indicate better quality of life. The aim was to culturally adapt and validate the LD-SRS questionnaire into Polish. Methods: The questionnaire has been translated from English into Polish by two translators. An expert team composed of physicians, nurses and a psychologist analysed the translations and developed the initial Polish version. It was translated back into English and analysed for the differences from the original to work out the pre-final version. After approval by the local ethics committee, the pre-final version was applied to a group of 21 patients as a pilot study. Then, the final version of the form was developed and tested once on the group of 77 children, mean age 13.9 years (8-20 years), and twice on the group of 34 children, mean age 15.9 years (12-19 years). The retest was obtained within 7 days (4-15 days). Results: The Cronbach’s alpha was 0.92, showing excellent internal consistency. The ICC value for total LD-SRS score (0.99) signified excellent reliability. The overall total LD-SRS score was 3.8 (SD=0.6). The results in each category were: function/activity 3.4 (SD=0.7), pain 3.9 (SD=1.0), self-image 3.5 (SD=0.7), mental health 3.6 (SD=1.0), satisfaction with management 4.2 (SD=0.8). We found no floor or ceiling effect for the total LD-SRS score. Conclusions: The Polish version of the LD-SRS questionnaire was found to be a reliable instrument with excellent internal consistency and can be used in assessing the quality of life of children treated for limb deformities.