Strategies in Trauma and Limb Reconstruction

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VOLUME 18 , ISSUE 1 ( January-April, 2023 ) > List of Articles

Original Article

Amputation vs Reconstruction in Type IV Tibial Hemimelia: Functional Outcomes and Description of a Novel Surgical Technique

Chun Hong Tang, Abdullah Addar, James A Fernandes

Keywords : Amputation, Deformity correction, Limb reconstruction, Skeletal dysplasia, Tibial hemimelia

Citation Information : Tang CH, Addar A, Fernandes JA. Amputation vs Reconstruction in Type IV Tibial Hemimelia: Functional Outcomes and Description of a Novel Surgical Technique. 2023; 18 (1):32-36.

DOI: 10.5005/jp-journals-10080-1576

License: CC BY-NC-SA 4.0

Published Online: 31-05-2023

Copyright Statement:  Copyright © 2023; The Author(s).


Introduction: The management of tibial hemimelia can be complex and involve either amputation or reconstruction. The decision made carries significant implications on patients and their families. This is a case series in the management of Type IV tibial hemimelia with a description of a novel surgical technique in the reconstructive arm of the pathway. Materials and methods: The study included four patients with bilateral tibial hemimelia have an amputation in one limb and reconstructive surgery on the other. The reconstruction involved a supratalar double osteotomy of the tibia and fibula, followed by a staged hindfoot osteotomy using a circular ring fixator. Functional outcomes are reported using the Special Interest Group in Amputee Medicine (SIGAM) and the short form 12 (SF-12) methods. Results: The mean age of patients in our cohort is 14 years (3–27 years) with mean age of surgery at 3 years. One case had an amputation following initial reconstructive surgery due to psychological distress and regressive behaviour. SIGAM functional outcome scores of F were recorded in three of four cases, with one patient performing at level B. On the reconstructive side, two of three patients reported a mean physical short form 12 (SF-12) score of 56.7 and a mental SF-12 score of 55.7. One patient reported a physical SF-12 score of 28.5 and a mental SF-12 score of 30.3. Discussion and conclusion: A reconstructive option provides a satisfactory functional outcome, comparable to the population mean, in the majority of patients in our cohort. Clinical significance: A staged supratalar double osteotomy followed later by a hindfoot osteotomy is effective in centralising the ankle and creates a plantigrade weight-bearing platform for ambulation in patients with Type IV tibial hemimelia.

  1. Dhanakodi N, Tripathy SK. Gollop-Wolfgang syndrome. Indian J Med Res 2014;139(6):963–964. PMID: 25109738.
  2. Jones D, Barnes J, Lloyd-Roberts G. Congenital aplasia and dysplasia of the tibia with intact fibula. Classification and management. J Bone Joint Surg Br 1978;60-B(1):31–39. DOI: 10.1302/0301-620X.60B1.627576.
  3. Clinton R., Birch JG. Congenital tibial deficiency: a 37-year experience at 1 institution. J Pediatr Orthop 2015;35(4):385–390. DOI: 10.1097/BPO.0000000000000280.
  4. Weber M. New classification and score for tibial hemimelia. J Child Orthop 2008;2(3):169–175. DOI: 10.1007/s11832-008-0081-5.
  5. Paley D. Tibial hemimelia: new classification and reconstructive options. J Child Orthop 2016;10(6):529–555. DOI: 10.1007/s11832-016-0785-x.
  6. Calder P, Shaw S, Roberts A, et al. A comparison of functional outcome between amputation and extension prosthesis in the treatment of congenital absence of the fibula with severe limb deformity. J Child Orthop 2017;11(4):318–325. DOI: 10.1302/1863-2548.11.160264.
  7. Ilizarov GA The tension-stress effect on the genesis and growth of tissues. Part I. The influence of stability of fixation and soft-tissue preservation. Clin Orthop 1989;(238):249–281. PMID: 2910611.
  8. Ilizarov GA. The tension-stress effect on the genesis and growth of tissues: part II. The influence of the rate and frequency of distraction. Clin Orthop 1989;(239):263–285. PMID: 2912628.
  9. Ilizarov GA, Lediaev VI, Shitin VP. The course of compact bone reparative regeneration in distraction osteosynthesis under different conditions of bone fragment fixation (experimental study). Eksp Khir Anesteziol 1969;14(6):3–12. PMID: 5385792.
  10. De Bastiani G, Aldegheri R, Renzi-Brivio L, Trivella G. Limb lengthening by callus distraction (callotasis). J Pediatr Orthop 1987;7(2):129–134. DOI: 10.1097/01241398-198703000-00002.
  11. Syme J. On amputation at the ankle joint. Lond Edinb Mon J Med Sci 1843l;3:93. DOI: 10.1016/S0140-6736(02)37748-1.
  12. Oppenheim WL. Fibular deficiency and the indications for Syme's amputation. Prosthet Orthot Int 1991;15(2):131–136. DOI: 10.3109/03093649109164648.
  13. Birch JG, Lincoln TL, Mack PW, Birch CM. Congenital fibular deficiency: a review of thirty years’ experience at one institution and a proposed classification system based on clinical deformity. J Bone Joint Surg Am 2011;93(12):1144–1151. DOI: 10.2106/JBJS.J.00683.
  14. Chong DY, Paley D. Deformity reconstruction surgery for tibial hemimelia. Children 2021;8(6):461. DOI: 10.3390/children8060461.
  15. Kumar Sahoo P, Sahu MM, Prasad Das S. Clinical spectrum of congenital tibial hemimelia in 35 limbs of 24 patients: a single center observational study from India. Eur J Med Genet 2019;62(7):103666. DOI: 10.1016/j.ejmg.2019.05.005.
  16. Wada, A, Nakamura T, Urano N, et al. Foot centralization for tibial hemimelia. J Pediatr Orthop B 2015;24(2):147–153. DOI: 10.1097/BPB.0000000000000149.
  17. Shahcheraghi GH, Javid M. Functional assessment in tibial hemimelia (can we also save the foot in reconstruction?). J Pediatr Orthop 2016;36:572–581. DOI: 10.1097/BPO.0000000000000513.
  18. Foster PAL, Barton SB, Jones SCE, et al. The treatment of complex tibial shaft fractures by the Ilizarov method. J Bone Joint Surg Br 2012; 94-B(12):1678–1683. DOI: 10.1302/0301-620X.94B12.29266.
  19. Mekhail AO, Abraham E, Gruber B et al. Bone transport in the management of posttraumatic bone defects in the lower extremity. J Trauma Inj Infect Crit Care 2004;56:368–378. DOI: 10.1097/01.TA.0000057234.48501.30.
  20. Brinker MR, O'Connor DP. Outcomes of tibial nonunion in older adults following treatment using the Ilizarov method. J Orthop Trauma 2007;21(9):634–642. DOI: 10.1097/BOT.0b013e318156c2a2.
  21. Robinson PM, Papanna MC, Somanchi BV, Khan SA. High tibial osteotomy in medial compartment osteoarthritis and varus deformity using the Taylor spatial frame: early results. Strateg Trauma Limb Reconstr 2011;6(3):137–145. DOI: 10.1007/s11751-011-0123-2.
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