Fibular Transfer in Tibial Hemimelia A Follow-up Study
DEBORAH CHRISTINI, P.T. AND S. JAY KUMAR, M.D.
The purpose of this study is to examine the long-term results of all patients diagnosed with complete absence of tibia who underwent fibular centralization. We were particularly interested in gait, compared with patients who had abovethe-knee amputations. Controversy exists as to whether the initial surgical procedure of fibular centralization yields satisfactory results acceptable by both the patient and physician. We considered a satisfactory outcome to include knee range of motion 10 to 80 degrees, good prosthetic fit, and an acceptable gait without use of assistive devices. Between 1964 and 1986, nine patients underwent 10 fibular centralizations by the Brown technique. Patients' charts were reviewed and seven patients were contacted by telephone at the time of this writing. Five males and four females were followed an average of 11 years since the transfer ranging from four to seven years. Three patients had bilateral tibial hemimelia. Three patients had above-the-knee amputations. Associated defects were also noted in two other patients. Six Boyd and three Syme amputations were performed an average of 2V2 years after the fibular transfer with a range of zero to five years. Four patients eventually required a knee disarticulation secondary to uncontrollable knee flexion contractures. Five transfers in patients with patellas and active quadriceps report satisfactory results wearing a below-the-knee prosthesis. One patient was unable to be contacted at this time. Preliminary results indicate that fibular centralization should be considered in patients with a patella, active quadriceps and possibly minimal knee flexion contracture. Gait was better in patients who had fibular centralization than in those with above-the-knee amputations.
Alfred I. duPont Institute, PO Box 269, Wilmington, DE 19899