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The Boyd amputation in children: indications and outcomes
David E Westberry1, Jon R Davids, Linda I Pugh
1*Department of Pediatric Orthopaedic Surgery ‡Shriners Hospital for Children, Greenville, SC †Department of Orthopaedic Surgery, Motion Analysis Laboratory, Shriners Hospitals for Children, Sacramento, CA.
Journal of Pediatric Orthopedics
|July 23, 2013
Summary
The Boyd procedure effectively treats pediatric lower extremity deficiencies, enabling prosthetic fitting. Further interventions may be needed for optimal limb growth and function.
Area of Science:
- Orthopedic Surgery
- Pediatric Limb Reconstruction
- Prosthetics & Orthotics
Background:
- Pediatric amputations necessitate careful planning for optimal residual limb development.
- Long-term strategies are crucial to accommodate growth in pediatric limb deficiencies.
Purpose of the Study:
- To evaluate the efficacy and outcomes of the Boyd procedure (calcaneotibial fusion) in pediatric limb deficiency.
- To analyze indications, complications, and prosthetic management following the Boyd procedure.
Main Methods:
- Retrospective review of 117 Boyd procedures in 109 pediatric patients over 15 years.
- Chart and radiographic analysis to assess surgical outcomes, complications, and prosthetic fitting.
- Evaluation of growth-related changes and fusion site morphology.
Main Results:
- The Boyd procedure was performed in children with a mean age of 2.8 years, primarily for postaxial limb bud deficiency (66%).
- Concomitant procedures occurred in 24%, with 33% requiring additional interventions for optimization or complications.
- A 14% complication rate was observed, highest in cases of congenital pseudoarthrosis of the tibia. Most patients achieved end-bearing prosthetic use.
Conclusions:
- The Boyd procedure is a viable surgical option for pediatric lower extremity conditions.
- Optimizing residual limbs may require additional procedures post-Boyd procedure for long-term success.
