title: A review of the aetiological factors and results of trans-ankle (Syme) disarticulations.
abstract: BACKGROUND
  Ever since James Syme described his amputation at the ankle joint, most authors have agreed that Syme's amputation should not be considered for patients with diabetic vascular disease (DVD). The aim of the study was to record our experience with Syme's amputations and to search for any predictive criteria that may enhance successful results.
  
  
  METHODS
  Seventy patients underwent a Syme amputation between the years 1980 and 2000 in our department, 51 owing to DVD. The other 19 patients had their amputations because of other pathologies.
  
  
  RESULTS
  The 19 patients of the non-DVD group showed a success rate of 94.7% (18/19). The overall success rate of the DVD patients was 49% (25/51). When we analysed the DVD group by age, the cut-off point was 65 years old. Patients aged 65 or less had a success rate of 68.2% (15/22), and over the age of 65 years the success rate was only 30.8% (8/26).
  
  
  CONCLUSIONS
  Patients with DVD should be considered good candidates for a Syme amputation if they are younger than 65 years old.
authors.affiliation: Orthopaedic Rehabilitation Department, Sheba Medical Centre, Tel-Hashomer 52621, Israel.
authors.forename: I
authors.initials: I
authors.lastname: Siev-Ner
authors.forename: M
authors.initials: M
authors.lastname: Heim
authors.forename: M
authors.initials: M
authors.lastname: Warshavski
authors.forename: A
authors.initials: A
authors.lastname: Daich
authors.forename: E
authors.initials: E
authors.lastname: Tamir
authors.forename: I
authors.initials: I
authors.lastname: Dudkiewicz
mesh_terms: D000368:Aged; D000671:Amputation, Surgical / Q000379:methods*; D000674:Amputees / Q000534:rehabilitation*; D000843:Ankle Joint / Q000601:surgery*; D003925:Diabetic Angiopathies / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016491:Peripheral Vascular Diseases / Q000209:etiology / Q000601:surgery*; D012189:Retrospective Studies; D016896:Treatment Outcome