Complications of Limb Salvage in Concordant Bilateral Fibular Hemimelia and Tetramelic Ectrodactyly: A Case Report

Introduction: Fibular hemimelia (FH) is a rare congenital limb deficiency that presents with ankle instability, limb length discrepancy, and valgus malalignment, which can coexist with additional limb malformations that can, in turn complicate reconstruction and long-term function. Case Report: We report a 19-year-old male with congenital bilateral FH, as well as tetramelic ectrodactyl, who pursued limb salvage pathways since infancy despite early consideration of amputation. His course in turn required staged, multidisciplinary management including multiple corrective reconstructive orthopedic procedures, bilateral tibial osteotomies, and external fixation-based reconstruction, with a major limb-lengthening operation in June 2022, which achieved substantial gains of 11 centimeter left and 7 centimeter right that was complicated by right fixator malfunction requiring operative replacement. After a course of rehabilitation, he then achieved meaningful improvements in both mobility and quality of life, allowing him to return to high-demand athletics, including wrestling. Due to progressive right ankle pain and instability from worsening alignment, a revised right ankle realignment and reconstruction with distal tibia osteotomy and internal fixation was performed in June 2025. The post-operative course was complicated by poor wound healing of the right medial foot that progressed to exposed bone and Staphylococcus epidermidis osteomyelitis requiring excisional debridement in September 2025. Margins were unable to exclude residual infection. Management with wound-vacuum therapy and prolonged intravenous daptomycin followed by oral doxycycline suppression pending hardware removal was confirmed in December 2025 with coordinated outpatient infusion, rehabilitation, and wound care follow-up. Conclusion: This case demonstrates patient-centered tradeoffs between limb salvage and amputation, the rationale behind elective staged reconstruction to optimize alignment and function, and the importance of multidisciplinary surveillance for late complications.