title: Osteocartilaginous transfer of the proximal part of the fibula for osseous overgrowth in children with congenital or acquired tibial amputation: surgical technique and results.
abstract: BACKGROUND
  Osseous overgrowth is a common problem in children after tibial transcortical amputation. We present the results of forty-seven children (fifty tibiae) treated for tibial osseous overgrowth with an autologous osteocartilaginous cap from the proximal part of the ipsilateral fibula.
  
  
  METHODS
  We reviewed the records of all patients who underwent amputation at a single pediatric hospital from 1990 to 2011. All patients who had been followed for a minimum of two years after undergoing osteocartilaginous capping with the proximal part of the ipsilateral fibula to treat established tibial overgrowth were included. Patients with acquired and congenital amputations were compared.
  
  
  RESULTS
  Fifty tibiae in forty-seven patients met our inclusion criteria. There were thirty-one acquired and nineteen congenital amputations. The mean age at surgery was 7.6 years (range, 2.1 to 15.6 years), and the mean duration of follow-up was 7.2 years (range, 2.2 to 15.4 years). Five tibiae (10%) in four patients had recurrence of the overgrowth at a mean of 5.4 years (range, 2.8 to 7.6 years) after the osteocartilaginous transfer. There was no significant difference in the results between children with an acquired amputation and those with a congenital amputation.
  
  
  CONCLUSIONS
  At a mean of 7.2 years after autologous osteocartilaginous capping with the proximal part of the fibula, 90% of the limbs had not had recurrent overgrowth. This is a safe and effective treatment of long-bone overgrowth following either congenital or acquired amputation in children.
authors.affiliation: Shriners Hospitals for Children Honolulu, 1310 Punahou Street, Honolulu, HI 96826. E-mail address: gfedorak@shrinenet.org.
authors.forename: Graham T
authors.initials: GT
authors.lastname: Fedorak
authors.affiliation: Shriners Hospitals for Children, Los Angeles, 3160 Geneva Street, Los Angeles, CA 90020.
authors.forename: Hugh G
authors.initials: HG
authors.lastname: Watts
authors.affiliation: Department of Orthopedic Surgery, University of North Carolina, UNC School of Medicine, 3147 Bioinformatics Building, 130 Mason Farm Road, Chapel Hill, NC 27599-7055.
authors.forename: Anna V
authors.initials: AV
authors.lastname: Cuomo
authors.affiliation: Harbor-UCLA Medical Center, 1000 West Carson Street, Torrance, CA 90502.
authors.forename: Julian P
authors.initials: JP
authors.lastname: Ballesteros
authors.affiliation: Human Mobility Research Centre, Queen's University, 76 Stuart Street, Kingston, ON K7L 2V7, Canada.
authors.forename: Heather J
authors.initials: HJ
authors.lastname: Grant
authors.affiliation: Orthopaedic Institute for Children, 403 West Adams Boulevard, Los Angeles, CA 90007.
authors.forename: Richard E
authors.initials: RE
authors.lastname: Bowen
authors.affiliation: Orthopaedic Institute for Children, 403 West Adams Boulevard, Los Angeles, CA 90007.
authors.forename: Anthony A
authors.initials: AA
authors.lastname: Scaduto
mesh_terms: D000293:Adolescent; D000671:Amputation, Surgical; D000673:Amputation, Traumatic / Q000601:surgery*; D016025:Bone Transplantation; D002648:Child; D002675:Child, Preschool; D005260:Female; D005360:Fibula / Q000473:pathology* / Q000637:transplantation*; D006801:Humans; D008297:Male; D013977:Tibia / Q000601:surgery*; D016896:Treatment Outcome