Case study: Correction of angular deformity post-trans-tibial amputation to improve prosthesis fit and comfort.
BACKGROUND
This case report describes the revision of a trans-tibial amputation complicated by a proximal malunited fracture. It demonstrates the complexity of decisions involved in revisions of this nature.


METHODS
The patient presented has a painful stump due to breakdown of soft tissues. She had been suffering for over a year with pressure sores and inability to use a prosthesis resulting from this, decreasing her quality of life. Malunion of a tibial fracture proximal to the amputation complicated her condition.


RESULTS
Initially it was feared that the amputation level would be converted to a through-knee amputation, but wedge osteotomy of the tibia allowed coverage of the stump, increasing functionality for the patient, while still maintaining a below-knee stump.


CONCLUSIONS
This report highlights the importance of addressing the cause of soft tissue problems in an amputation revision, which must be addressed on a case-by-case basis.


CONCLUSIONS
This case offers an insight into the decision-making process in limb reconstruction and suggests a solution for similar cases. It is important that all surgical options are considered before amputation length is sacrificed.
Department of Trauma and Orthopaedics, Leeds Teaching Hospitals, Leeds, UK bethbrown@doctors.org.uk.
Beth
B
Lineham
Department of Trauma and Orthopaedics, Leeds Teaching Hospitals, Leeds, UK.
Paul
P
Harwood
Department of Trauma and Orthopaedics, Leeds Teaching Hospitals, Leeds, UK.
Peter
P
Giannoudis
D000063:Accidents, Traffic; D000674:Amputees / Q000534:rehabilitation*; D001186:Artificial Limbs; D005260:Female; D017759:Fractures, Malunited / Q000150:complications* / Q000601:surgery; D006801:Humans; D016916:Joint Deformities, Acquired / Q000209:etiology / Q000628:therapy*; D007719:Knee Joint / Q000601:surgery; D017060:Patient Satisfaction; D011474:Prosthesis Design; D017755:Prosthesis Fitting; D011788:Quality of Life; D012086:Reoperation; D013977:Tibia / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult
Amputation; prosthesis fitting; revision; trans-tibial