Functional Classification of Birch et al for Fibular Deficiency

Birch et al developed a functional classification for fibular deficiency. This can help guide decision making in patient management.

Parameters:

(1) functional foot

(2) limb length inequality (discrepancy)

(3) functional upper extremity

The presence or absence of a functional foot is the primary distinction between Types I and II.

Type	Management Recommendation
IA	orthosis or epiphysiodesis
IB	epiphysiodesis with/without lengthening
IC	1 or 2 lengthenings vs amputation
ID	3 or more lengthenings vs amputation
IIA	early amputation
IIB	consider salvage

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