[Tibial aplasia. Treatment by tibialization of the fibula and compensation for shortening by holding the foot in equinus position in Bangui, Central African Republic].

Objective: Congenital absence of the tibia (congenital tibial aplasia) causes significant disability when walking. The usual treatment, which involves lengthening the lower leg or early amputation followed by prosthetic fitting, requires technical resources that are often lacking in developing countries. The proposed alternative consists of tibialization of the fibula with limb lengthening and by preservation of the foot equinismus. Patients and method: The records of 25 children with congenital tibial aplasia were reviewed. Ten of these children underwent tibialization of the fibula (operated between one and three years of age) and amputation (at six and eight years of age) in two cases. Results: With a mean follow-up period of two years and seven months, correct alignment of the lower leg and foot below the knee was achieved in all cases of tibialization of the fibula. Two children achieved independent walking. Three children were lost for follow-up. Discussion: The management of congenital tibial aplasia must consider the local socioeconomic context. Although the follow-up period in this study is short, the protocol is simple and well-accepted by families. Conclusion: Conservative treatment of tibial aplasia through tibialization of the fibula with equinus preservation to compensate the shortening is simple and takes local socioeconomic constraints into account, while avoiding the limitations and costs of modern protocols. Furthermore, it is always well accepted by families.