Leg-length inequality in children treated by Syme's amputation

Area of Science:

• Orthopedic Surgery
• Pediatric Orthopedics
• Limb Reconstruction

Background:

• Congenital leg-length discrepancy (LLD) presents a significant challenge in pediatric orthopedic management.
• Syme's amputation, an ankle disarticulation, is one surgical option for managing severe LLD.
• Evaluating long-term functional outcomes in children undergoing Syme's amputation is crucial for guiding treatment decisions.

Purpose of the Study:

• To review the functional outcomes of Syme's amputation in children with congenital leg-length discrepancy.
• To identify factors influencing the success of this surgical procedure.
• To establish recommendations for the optimal timing and patient selection for Syme's amputation.

Main Methods:

• Retrospective review of 37 children who underwent Syme's amputation for congenital LLD.
• Mean follow-up period of 7.6 years post-operatively.
• Assessment of functional outcomes, patient-reported activity levels, and surgical complications.

Main Results:

• Good functional results were achieved in the majority of patients.
• 18 out of 37 patients reported unrestricted activities post-surgery.
• The primary condition necessitating the amputation was the main determinant of functional outcome.
• Common complications like heel pad migration were manageable with prosthetics.

Conclusions:

• Syme's amputation is a viable and well-tolerated procedure in younger children with congenital LLD.
• For predicted LLD exceeding 15 cm with foot abnormalities, primary Syme's amputation between 18 months and two years is recommended.
• Early surgical intervention can lead to favorable functional results and improved quality of life.