Benign curved tibia

Fabrice Cuillier, MD1, Berta A2, M’Lamali H., MD3

1 Department of Gynecology, Felix Guyon Hospital, 97400 Saint-Denis, Reunion Island, France. 
2 Student. Arizona State University. University Drive and Mill Avenue Tempe, Arizona 85281, USA.
3 Department of Gynecology, Saint-Martin Hospital, 97460 Saint-Paul, Reunion Island, France. 

Case report:

A 30-year-old patient, G4P3, with unremarkable history was referred to our department at 34 weeks. A unilateral lower limb malformation was suspected. The mother did not take any medication. There were no previous maternal infectious diseases.

Ultrasound at 12 weeks (NT=1 mm) and at 24 weeks showed a single fetus of appropriate-for-gestational age. At 33 weeks, right club foot was suspected. We observed a normal right femur (64mm), but right fibula and tibia was hypoplastic (Image 1, 2). The right foot has five metatarsal bone and five toes but in hyperflexed position (Image 3, 4). The left leg was normal. There were no other abnormal findings. Left and right humerus, radius and ulna were also normal.

The parents were counseled by a pediatric orthopedic surgeon about postnatal prognosis. The fetal karyotype was normal (46 XX) corresponding to sex phenotype.

The baby was born at 38 weeks. Neonatal examination confirmed diagnosis. Neonatal X-rays showed fibular and tibia hypoplasia. Theorically, in the future, normal foot straightening is possible, with a risk of hypoplasic tibial accentuation. 

Image 1-4: At 34 weeks, normal right femur, hypoplasia of right tibia and fibula

1A-
1B-

Image3, 4: Right leg with hyperflexed position

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1E-

Image 5:  Upper limbs.

3A-(2)

Image 6-9: MRI and Spiral scanning

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4B
4C34SA
4D

Image 10 : Post-natal appearance

5-V

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