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Tibia vara deformity after below knee amputation and synostosis formation in children
Lee S Segal1, Robin C Crandall
1Division of Pediatric Orthopaedics, Phoenix Children's Hospital, Phoenix, AZ 85016, USA. lsegal@phoenixchildrens.com
Journal of Pediatric Orthopedics
|April 9, 2009
Summary
Distal tibia-fibula synostosis is a key factor in progressive varus deformity in pediatric amputees, impacting prosthetic fit. Early detection and interventions like lateral proximal tibial hemi-epiphyseodesis are crucial for managing this condition.
Area of Science:
- Orthopedic surgery
- Pediatric orthopedics
- Amputee rehabilitation
Background:
- Progressive varus deformity of the tibia in pediatric amputees is not well-documented.
- Distal tibia-fibula synostosis is frequently observed in these patients, potentially linked to surgical creation or spontaneous occurrence.
- This deformity poses challenges for prosthetic wear and requires investigation into its causes and treatments.
Purpose of the Study:
- To investigate the causes of progressive varus deformity in pediatric amputees.
- To analyze the implications of this deformity on prosthetic use.
- To explore potential treatment strategies for varus deformity in pediatric amputees.
Main Methods:
- Retrospective review of 12 pediatric amputee patients with progressive varus deformity from two centers.
- Analysis of amputation levels (transtibial, Syme) and etiology (congenital constriction band syndrome).
- Radiographic assessment of tibial angles and surgical interventions performed.
Main Results:
- Distal tibia-fibula synostosis was present in 92% of affected limbs.
- The mean proximal medial tibial angle was 80.5 degrees.
- Ten patients underwent corrective procedures including osteotomies and hemi-epiphyseodesis; two received no correction.
Conclusions:
- Distal tibiofibular synostosis may cause progressive varus deformity in pediatric amputees by disrupting longitudinal growth.
- Prosthetic modifications or surgical correction may be necessary for severe deformities.
- Early detection and interventions like lateral proximal tibial hemi-epiphyseodesis can be effective.
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