Introduction
Although rare, congenital fibular deficiency (CFD), also called fibular hypoplasia and fibular hemimelia, is the most common congenital
long bone deficiency, with an approximate incidence of 7.4 to 20 per 1 million live births.
Clinical features
CFD is usually apparent at birth and can vary from mild limb inequalities and asymmetry to severe shortening, with a wide range of associated anomalies , including knee , femur , foot and ankle and might be associated with upper limb deformities
Classification
2 well known classifications
1- Achterman and Kalamchi Classification System for Congenital Fibular Deficiency
Anatomic and based on radiographic features.
2- BIRCH classification , according to the foot preservation
Management
1- Non operative , in mild cases
2- Operative includes , epiphysiodesis , amputation and reconstructive surgery
Conclusion :
Congenital absent fibula should be assessed as a whole limb deformity
It is a team work action , not only surgery
Should acknowledge the culture of the people and involve the family in the decision