Failure of centralization of the fibula for congenital longitudinal deficiency of the tibia

Between 1962 and 1983, fourteen patients (twenty knees) had centralization of the fibula for congenital longitudinal deficiencytibial, complete. Eleven of the twenty index procedures were performed on patients who were one year old or less. A progressive flexion deformity of the knee developed after...

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Bibliographic Details
Published in:	Journal of bone and joint surgery. American volume Vol. 73; no. 6; pp. 858 - 867
Main Authors:	Epps, C H, Tooms, R E, Edholm, C D, Kruger, L M, Bryant, D D
Format:	Journal Article
Language:	English
Published:	Boston, MA Copyright by The Journal of Bone and Joint Surgery, Incorporated 01-07-1991 Journal of Bone and Joint Surgery Incorporated
Subjects:	Amputation Artificial Limbs Biological and medical sciences Child, Preschool Contracture - etiology Disarticulation Fibula - surgery Follow-Up Studies Humans Infant Infant, Newborn Knee Joint Leg Leg Length Inequality - surgery Medical sciences Orthopedic surgery Postoperative Complications Reoperation Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases Tibia - abnormalities Centralization Human Fibula Orthopedic surgery Treatment Aplasia Congenital Malformation Tibia Diseases of the osteoarticular system Lower limb Technique
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Summary:	Between 1962 and 1983, fourteen patients (twenty knees) had centralization of the fibula for congenital longitudinal deficiencytibial, complete. Eleven of the twenty index procedures were performed on patients who were one year old or less. A progressive flexion deformity of the knee developed after all twenty index procedures. Twenty-six secondary procedures were needed, including disarticulation at the knee, posterior release, extension osteotomy, femorofibular arthrodesis, and biceps-to-quadriceps transfer, and one patient had a second attempt at centralization of the fibula. The duration of follow-up after the initial centralization of the fibula ranged from four years to twenty-two years and seven months (average, twelve years and four months). Seven patients (eight limbs) in whom the index procedure resulted in failure had a satisfactory result after disarticulation at the knee. The patients who did not have secondary disarticulation at the knee are also considered to have had a failed index procedure because they had a flexion deformity at the latest follow-up. Attempts to reconstruct the knee joint by centralization of the fibula are not warranted for patients who have congenital longitudinal deficiencytibial, complete. Early disarticulation at the knee and fitting with a prosthesis, with close follow-up, is the treatment of choice.
Bibliography:	ObjectType-Case Study-2 SourceType-Scholarly Journals-1 ObjectType-Feature-4 content type line 23 ObjectType-Report-1 ObjectType-Article-3
ISSN:	0021-9355 1535-1386
DOI:	10.2106/00004623-199173060-00008