Tibial Plateau Fracture in a Patient with Fibular Hemimelia: A Case Report.

Abstract

Introduction: Fibular hemimelia (FH) is the most common congenital longitudinal deficiency of the lower limb, characterized by partial or complete fibular absence and associated musculoskeletal abnormalities. Its coexistence with a traumatic tibial plateau fracture has not been previously reported in the literature. We present the first reported case of a comminuted bicondylar tibial plateau fracture occurring in a patient with complete congenital fibular absence and describe the specific anatomical and technical challenges encountered during surgical management.

Case report: A 37-year-old Portuguese man with congenital right-sided FH (Achterman and Kalamchi type II) sustained a comminuted Schatzker V tibial plateau fracture following a fall from an electric scooter. Staged management consisted of temporary external fixation followed by dual-plate open reduction and internal fixation. The congenitally altered proximal tibial geometry necessitated the use of a contralateral implant, as the standard ipsilateral plate did not conform adequately. Post-operative recovery was complicated by delayed union of the posteromedial fragment, complex regional pain syndrome, and a complete rupture of the anterior cruciate ligament of indeterminate origin. At 4 years of follow-up, the patient had persistent knee stiffness with flexion limited to 100°, early post-traumatic gonarthrosis, and ambulated with a single crutch.

Conclusion: Congenital fibular absence alters proximal tibial anatomy and neurovascular landmarks, complicating fracture fixation and requiring individualized surgical planning. However, the guarded long-term outcome and multiple confounding factors in this single case indicate that these anatomical observations should inform surgical vigilance rather than be generalized as a management protocol.