{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,30]],"date-time":"2026-01-30T21:19:11Z","timestamp":1769807951870,"version":"3.49.0"},"reference-count":15,"publisher":"BMJ","issue":"1","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2026,1,8]]},"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:p>An infant with equino-varus deformity of her right foot and flexion deformity of the knee presented to our centre. Based on clinical and radiological examination findings, she was diagnosed with Paley Va (Jones Ia) axial longitudinal intercalary deficiency of the right leg as the entire tibia was absent. Consequent to cultural non-acceptance of amputation by the parents, her management involved staged procedures. The initial surgery aimed to achieve fusion between the talus and the distal end of the fibula after soft tissue release and fibular shortening. In the subsequent surgery, Weber patelloplasty comprising rotation of the patella distally by 90\u00b0 and its fusion with the proximal fibula was performed. Complications included femoral osteomyelitis, skin necrosis and non-union at the site of the fibula and talus fusion, which were managed appropriately.<\/jats:p>\n                  <jats:p>Three years after the index procedure, the child has been walking with a stable, plantigrade foot, aided by a knee\u2013foot\u2013ankle orthosis and has a mobile knee joint with active movements. Although the reconstructed limb cannot be equated to a normal limb, the short-term outcomes show that reconstruction can be offered if parents do not consent for amputation and are willing to accept the prolonged duration of treatment.<\/jats:p>","DOI":"10.1136\/bcr-2025-269442","type":"journal-article","created":{"date-parts":[[2026,1,30]],"date-time":"2026-01-30T11:25:18Z","timestamp":1769772318000},"page":"e269442","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Paley Va Tibia hemimelia: challenges and mid-term outcomes"],"prefix":"10.1136","volume":"19","author":[{"given":"Ayesha","family":"Mohapatra","sequence":"first","affiliation":[{"name":"Othopedics, AIIMS Bhopal, Bhopal, Madhya Pradesh, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Prateek","family":"Behera","sequence":"additional","affiliation":[{"name":"Orthopaedics, AIIMS Bhopal, Bhopal, Madhya Pradesh, India"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2026,1,30]]},"reference":[{"key":"2026013003251368000_19.1.e269442.1","doi-asserted-by":"crossref","first-page":"712","DOI":"10.2106\/00004623-197658050-00025","article-title":"Ipsilateral femoral bifurcation and tibial hemimelia. A case report","volume":"58","author":"Ogden","year":"1976","journal-title":"J Bone Joint Surg"},{"key":"2026013003251368000_19.1.e269442.2","doi-asserted-by":"crossref","first-page":"858","DOI":"10.2106\/00004623-199173060-00008","article-title":"Failure of centralization of the fibula for congenital longitudinal deficiency of the tibia","volume":"73","author":"Epps","year":"1991","journal-title":"J Bone Joint Surg Am"},{"key":"2026013003251368000_19.1.e269442.3","first-page":"1333","article-title":"Construction of a knee joint in meromelia tibia. A fifteen-year follow-up study","volume":"54","year":".","journal-title":"J Bone Joint Surg Am"},{"key":"2026013003251368000_19.1.e269442.4","doi-asserted-by":"crossref","first-page":"250","DOI":"10.1097\/01202412-200507000-00003","article-title":"Treatment of tibial hemimelia without amputation: preliminary report","volume":"14","author":"Hosny","year":"2005","journal-title":"J Pediatr Orthop B"},{"key":"2026013003251368000_19.1.e269442.5","doi-asserted-by":"crossref","first-page":"160","DOI":"10.1097\/01241398-200003000-00005","article-title":"Ilizarov lengthening in centralized fibula","volume":"20","author":"Javid","year":"2000","journal-title":"J Pediatr Orthop"},{"key":"2026013003251368000_19.1.e269442.6","doi-asserted-by":"crossref","first-page":"695","DOI":"10.2106\/00004623-196547040-00004","article-title":"Construction of a knee joint in congenital total absence of the tibia (Paraxial tibial hemimelia). A preliminary report","volume":"47","author":"Brown","year":"1965","journal-title":"J Bone Joint Surg Am"},{"key":"2026013003251368000_19.1.e269442.7","doi-asserted-by":"crossref","first-page":"97","DOI":"10.1097\/00003086-197903000-00016","article-title":"Fibular transfer for congenital absence of the tibia","volume":"139","author":"Jayakumar","year":"1979","journal-title":"Clin Orthop Relat Res"},{"key":"2026013003251368000_19.1.e269442.8","first-page":"79","article-title":"Fibular transfer in a nine-week-old infant for complete congenital absence of the tibia","volume":"36","author":"Karakurt","year":"2002","journal-title":"Acta Orthop Traumatol Turc"},{"key":"2026013003251368000_19.1.e269442.9","article-title":"Deformity Reconstruction Surgery for Tibial Hemimelia","volume":"8","author":"Chong","year":"2021","journal-title":"Children (Basel)"},{"key":"2026013003251368000_19.1.e269442.10","doi-asserted-by":"publisher","DOI":"10.1007\/s00264-003-0490-5"},{"key":"2026013003251368000_19.1.e269442.11","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1302\/0301-620X.60B1.627576","article-title":"Congenital aplasia and dysplasia of the tibia with intact fibula. Classification and management","volume":"60","author":"Jones","year":"1978","journal-title":"J Bone Joint Surg Br"},{"key":"2026013003251368000_19.1.e269442.12","doi-asserted-by":"publisher","DOI":"10.1007\/s11832-008-0081-5"},{"key":"2026013003251368000_19.1.e269442.13","doi-asserted-by":"crossref","first-page":"529","DOI":"10.1007\/s11832-016-0785-x","article-title":"Tibial hemimelia: new classification and reconstructive options","volume":"10","author":"Paley","year":"2016","journal-title":"J Child Orthop"},{"key":"2026013003251368000_19.1.e269442.14","doi-asserted-by":"crossref","first-page":"378","DOI":"10.1097\/01241398-199305000-00020","article-title":"Fibular transfer for congenital absence of the tibia","volume":"13","author":"Christini","year":"1993","journal-title":"J Pediatr Orthop"},{"key":"2026013003251368000_19.1.e269442.15","doi-asserted-by":"crossref","first-page":"8","DOI":"10.1097\/01241398-198701000-00002","article-title":"Fibular transfer for congenital absence of the tibia: a reassessment","volume":"7","author":"Loder","year":"1987","journal-title":"J Pediatr Orthop"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2025-269442","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,30]],"date-time":"2026-01-30T11:25:22Z","timestamp":1769772322000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2025-269442"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1]]},"references-count":15,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,1,30]]},"published-print":{"date-parts":[[2026,1]]}},"alternative-id":["10.1136\/bcr-2025-269442"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2025-269442","relation":{},"ISSN":["1757-790X"],"issn-type":[{"value":"1757-790X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1]]}}}