Syme amputation in children: indications, results, and long-term follow-up

Syme amputations are not always effective. Heel pad migration, skin sloughs, and problems with prosthetic fitting may complicate a seemingly simple procedure. We reviewed 69 Syme amputations performed in 62 children at the Los Angeles Shriners Hospital between 1956 and 1980. The major indication was leg length discrepancy, due to either paraxial fibula hemimelia (33 cases) or proximal focal femoral deficiency (19 cases). The average age at amputation was 5.6 years, with an average follow-up of 10.5 years (range 1-25 years). The results were assessed by a combination of chart review, patient recall examinations, and questionnaires. Satisfaction in adulthood was high. Early complications included three skin sloughs and one infection. Late complications included 2 retained os calcis apophyses, 1 exostosis, and 16 cases of heel pad migration. Only one of the heel pad group required revision; prosthetic adjustment resolved the others. Prosthetic knees were often too low because of failure to limit the length of the stump appropriately. Syme amputation should be considered a primary reconstructive procedure, rather than a last resort, in fibula hemimelia and proximal femoral focal deficiency.