Failure of centralization of the fibula for congenital longitudinal deficiency of the tibia.
Between 1962 and 1983, fourteen patients (twenty knees) had centralization of the fibula for congenital longitudinal deficiency: tibial, complete. Eleven of the twenty index procedures were performed on patients who were one year old or less. A progressive flexion deformity of the knee developed after all twenty index procedures. Twenty-six secondary procedures were needed, including disarticulation at the knee, posterior release, extension osteotomy, femorofibular arthrodesis, and biceps-to-quadriceps transfer, and one patient had a second attempt at centralization of the fibula. The duration of follow-up after the initial centralization of the fibula ranged from four years to twenty-two years and seven months (average, twelve years and four months). Seven patients (eight limbs) in whom the index procedure resulted in failure had a satisfactory result after disarticulation at the knee. The patients who did not have secondary disarticulation at the knee are also considered to have had a failed index procedure because they had a flexion deformity at the latest follow-up. Attempts to reconstruct the knee joint by centralization of the fibula are not warranted for patients who have congenital longitudinal deficiency: tibial, complete. Early disarticulation at the knee and fitting with a prosthesis, with close follow-up, is the treatment of choice.
Epps
C H
CH
Handicapped and Crippled Children's Unit, District of Columbia General Hospital, Washington.
Tooms
R E
RE
Edholm
C D
CD
Kruger
L M
LM
Bryant
D D
DD
D000671:Amputation, Surgical; D001186:Artificial Limbs; D002675:Child, Preschool; D003286:Contracture / Q000209:etiology; D004188:Disarticulation; D005360:Fibula / Q000601:surgery*; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007719:Knee Joint; D007866:Leg; D007870:Leg Length Inequality / Q000601:surgery*; D011183:Postoperative Complications; D012086:Reoperation; D013977:Tibia / Q000002:abnormalities*