Brown's procedure for congenital absence of the tibia revisited.
The results of reconstructive surgery in tibial hemimelia using a modified fibular transfer procedure as described by Brown were reviewed. A modified Brown's procedure was carried out on five patients with a total of seven affected limbs. A Syme's-type amputation of the foot was carried out in each case. All of the knees had quadriceps function preoperatively, which was considered a prerequisite for surgery. Average length of follow-up was 7 years, with a range of 2-12 years. The average age at time of surgery was 12.7 months, with a range of 7-26 months. At the time of review, all patients had reasonably good function of their lower extremities. All were ambulating with patellar tendon-bearing prostheses and thigh extensions for collateral support. The average arc of motion at review was 57.4 degrees, with further passive motion possible in all cases. Average extension was -18.5 degrees, and the average active flexion was 76 degrees. We found that a fibular centralization procedure in a patient with at least grade III+ quadriceps function can give good functional results that do not appear to deteriorate over time.
Simmons
E D
ED
Children's Hospital of Boston, Harvard Medical School, Massachusetts, USA.
Ginsburg
G M
GM
Hall
J E
JE
D000015:Abnormalities, Multiple / Q000601:surgery; D000671:Amputation, Surgical; D001186:Artificial Limbs; D001696:Biomechanical Phenomena; D001858:Bone Nails; D005269:Femur / Q000002:abnormalities; D005360:Fibula / Q000637:transplantation*; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007719:Knee Joint / Q000503:physiopathology; D007866:Leg; D010329:Patella / Q000002:abnormalities; D016059:Range of Motion, Articular / Q000502:physiology; D012086:Reoperation; D013710:Tendons / Q000601:surgery; D013977:Tibia / Q000002:abnormalities* / Q000601:surgery*; D016896:Treatment Outcome