Preliminary report on amputation versus reconstruction in treatment of tibial hemimelia.
OBJECTIVE
Tibial hemimelia is a rare disorder characterized by the absence or hypoplasia of the tibia with associated rigidity. The aim of this study was to retrospectively evaluate the affectivity of reconstructive surgeries including centralization of the knee-ankle joints and lengthening with Ilizarov principles, as well as physical and functional results of amputation and reconstruction.


METHODS
This is an IRB-approved retrospective review of all patients diagnosed with tibial hemimelia who required surgery at a single institution between 1998 and 2011. Charts were analyzed for clinical and radiographical findings. At final follow-up, patients underwent physical and radiographic examination. Patients and their parents were asked to complete the SF-10™ health survey (QualityMetric Inc., Lincoln, RI, USA).


RESULTS
Twenty-one patients (12 male, 9 female) with 30 affected extremities were included. Mean age was 4.8±3.1 years at initial surgery. Knee level disarticulation was performed in 6 extremities of 4 patients. One patient with type III underwent transtibial amputation. Mean number of surgeries for each patient was 6.4±3.3, and mean duration of external fixator and casting was 17±6 months. Mean lengthening was 4.9±1.3 cm, and mean limb length discrepancy was 3.1±1.7 cm at 5.8±3.7 years at follow-up. SF-10™ scores were similar in disarticulated and reconstructed patients (p=0.63). All scores were significantly higher when disarticulation was performed in cases of knee instability (p<0.01).


CONCLUSIONS
When stability of the knee joint is present, treatment modality should be chosen according to the existence of the proximal tibia. Amputation should be preferred in cases of knee joint instability.
İstanbul University Istanbul Faculty of Medicine, Department of Orthopaedics and Traumatology, İstanbul, Turkey.
Halil İbrahim
Hİ
Balcı
İstanbul University Istanbul Faculty of Medicine, Department of Orthopaedics and Traumatology, İstanbul, Turkey.
Yavuz
Y
Sağlam
İstanbul University Istanbul Faculty of Medicine, Department of Orthopaedics and Traumatology, İstanbul, Turkey.
Fuat
F
Bilgili
İstanbul University Istanbul Faculty of Medicine, Department of Orthopaedics and Traumatology, İstanbul, Turkey.
Cengiz
C
Şen
İstanbul Memorial Hospital, Department of Orthopaedics and Traumatology, İstanbul, Turkey.
Mehmet
M
Kocaoğlu
İstanbul Memorial Hospital, Department of Orthopaedics and Traumatology, İstanbul, Turkey.
Levent
L
Eralp
D000671:Amputation, Surgical / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D004480:Ectromelia / Q000601:surgery*; D016267:External Fixators; D005260:Female; D005360:Fibula / Q000000981:diagnostic imaging; D006801:Humans; D018889:Ilizarov Technique; D007223:Infant; D007593:Joint Instability / Q000601:surgery*; D007719:Knee Joint / Q000601:surgery*; D007870:Leg Length Inequality / Q000601:surgery; D008297:Male; D011859:Radiography; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D013977:Tibia / Q000002:abnormalities* / Q000601:surgery; D016896:Treatment Outcome