Strategies in Trauma and Limb Reconstruction

Register      Login

VOLUME 14 , ISSUE 2 ( May-August, 2019 ) > List of Articles

TECHNICAL ARTICLE

Boyd Amputation Using the Tension Band Technique

Mauricio LD Mongon, Aurelio L Sposito, George MN Nunes, Bruno Livani, William Belangero

Keywords : Amputation, Cerclage wiring, Operative surgical procedure, Reconstruction

Citation Information : Mongon ML, Sposito AL, Nunes GM, Livani B, Belangero W. Boyd Amputation Using the Tension Band Technique. 2019; 14 (2):102-105.

DOI: 10.5005/jp-journals-10080-1433

License: CC BY-NC-SA 4.0

Published Online: 01-08-2019

Copyright Statement:  Copyright © 2019; Jaypee Brothers Medical Publishers (P) Ltd.


Abstract

Background: Amputation at the level of the hindfoot results in an equinus deformity from an imbalance of muscle-tendons acting across the ankle. Boyd’s reconstruction for hindfoot amputations is a well-known technique that retains the calcaneus and fuses it with the distal tibia at the ankle mortise. It provides an excellent weight-bearing stump and in most cases does not require an artificial limb but its use has been restricted because of the difficulty in obtaining high union rates in the tibiocalcaneal fusion. Materials and methods: Five patients (four unilateral and one bilateral) underwent leg amputations from January 2012 to November 2013 using the Boyd technique for reconstructing the stump and were stabilized with a tension band. The study sample consisted of adult patients who had traumatic reasons for the amputation. Patients under 18 years old with a hindfoot that was inadequate for Boyd reconstruction (i.e., insufficient soft tissue coverage or no posterior tibial artery pulse) were excluded. One (case #2) had systemic comorbidities (e.g., hypertension, diabetes, chronic vascular insufficiency) as well as being a smoker. Three men and two women (mean age 39 years; range 21–61 years) were included. Three patients underwent amputation on the right side, one on the left side, and one bilaterally (case #5). All patients presented with Gustillo and Anderson IIIC open fractures. The mean time from lesion to amputation was 2.25 weeks (range 1–4 weeks). The mean follow-up duration was 16 (range 12–24) months. The post-surgery examination included a clinical examination and radiography. A 6 minute walk test (6 MWT) was performed on week 32 after the amputation. This study was carried out with the approval of our institution’s ethics committee. All patients provided a written informed consent form in accordance with the World Medical Association and the Declaration of Helsinki. Results: All six stumps fused successfully. The 6 MWT results were comparable to those found in the literature for other lower limb amputees. Conclusion: The tension band technique used as part of the Boyd amputation to achieve tibiocalcaneal fusion was effective in all five trauma patients. Sound fusion was achieved in all cases with the 6 MWT scores comparable to that in the literature. This technique should be considered an osteosynthesis option for the Boyd procedure. Level of evidence: Level IV, retrospective study.


PDF Share
  1. Harris RI. Syme’s amputation; the technical details essential for success. J Bone Joint Surg Br 1956;38–B(3):614–632.
  2. Kornah B. Modified boyd amputation. J Bone Jt Surg 1996;78(1): 149–150. DOI: 10.1302/0301-620X.78B1.0780149.
  3. Blum E. Boyd amputations In children. Clin Orthop Relat Res 1939. 138–143.
  4. Kirkup J. Elective amputation: early evolution to the end of the 17th century. A history of limb amputation. London: Springer; 2007. 55–67.
  5. Livani B, de Castro GF, Tonelli Filho JR, et al. Pedicled sensate composite calcaneal flap to achieve full weight-bearing surface in midshaft leg amputations: case report. J Reconstr Microsurg 2011;27(1):63–66. DOI: 10.1055/s-0030-1267831.
  6. Mongon MLD, Garcia Costa KV, Bittar CK, et al. Tibiotalar arthrodesis in posttraumatic arthritis using the tension band technique. Foot Ankle Int 2013;34(6):851–855. DOI: 10.1177/1071100713483097.
  7. Mongon MLD, Ribera FC, de Souza AMA, et al. Pedicled sensate composite calcaneal flap in children with congenital tibial pseudoarthrosis. J Pediatr Orthop 2017;37(4):e271–e276. DOI: 10.1097/BPO.0000000000000942.
  8. Butland R, Pang J, Gross ER, et al. Two-, six-, and 12-minute walking tests in respiratory disease. Britsh Med J 1982;284(6329):1607–1608. DOI: 10.1136/bmj.284.6329.1607.
  9. Lin-Chan S, Nielsen D, Shurr D, et al. Physiological responses to multiple speed treadmill walking for syme vs. transtibial amputation—a case report. Disabil Rehabil 2003;25(23):1333–1338. DOI: 10.1080/09638280310001608618.
  10. McGavin CR, Gupta SP, McHardy GJR. Twelve-minute walking test for assessing disability in chronic bronchitis. Br Med J 1976;1(6013):822–823. DOI: 10.1136/bmj.1.6013.822.
  11. Montgomery PS, Gardner AW. The clinical utility of a six-minute walk test in peripheral arterial occlusive disease patients. J Am Geriatr Soc 1998;46(6):706–711. DOI: 10.1111/j.1532-5415.1998.tb03804.x.
  12. Mungall IPF, Hainsworth R. Assessment of respiratory function in patients with chronic obstructive airways disease. Thorax 1979;34(2):254–258. DOI: 10.1136/thx.34.2.254.
  13. Nather A, Wong KL. Distal amputations for the diabetic foot. Diabet Foot Ankle 2013;4(1):4–7. DOI: 10.3402/dfa.v4i0.21288.
  14. Mongon ML, Piva FA, Mistro Neto S, et al. Cortical tibial osteoperiosteal flap technique to achieve bony bridge in transtibial amputation: experience in nine adult patients. Strateg Trauma Limb Reconstr 2013;8(1):37–42. DOI: 10.1007/s11751-013-0152-0.
  15. Anon. ATS Statement. Am J Respir Crit Care Med 2002;166(1):111–117. DOI: 10.1164/ajrccm.166.1.at1102.
  16. Gailey RS, Roach KE, Applegate EB, et al. The amputee mobility predictor: an instrument to assess determinants of the lower-limb amputee’s ability to ambulate. Arch Phys Med Rehabil 2002;83(5):613–627. DOI: 10.1053/apmr.2002.32309.
  17. Linberg AA, Roach KE, Campbell SM, et al. Comparison of 6-minute walk test performance between male active duty soldiers and servicemembers with and without traumatic lower-limb loss. J Rehabil Res Dev 2013;50(7):931–940. DOI: 10.1682/JRRD.2012.05.0098.
  18. Wurdeman SR, Schmid KK, Myers SA, et al. Step activity and 6-minute walk test outcomes when Wearing low-activity or high-activity prosthetic feet. Am J Phys Med Rehabil 2017;96(5):294–300. DOI: 10.1097/PHM.0000000000000607.
  19. Tarkin IS, Sop A, Pape H. High-energy foot and ankle trauma: principles for formulating an individualized care plan. Foot Ankle Clin NA 2008;13(4):705–723. DOI: 10.1016/j.fcl.2008.08.002.
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.