Osteocartilaginous Transfer of the Proximal Part of the Fibula for Osseous Overgrowth in Children with Congenital or Acquired Tibial Amputation

Abstract

At a mean of 7.2 years after autologous osteocartilaginous capping with the proximal part of the fibula, 90% of the limbs had not had recurrent overgrowth. This is a safe and effective treatment of long-bone overgrowth following either congenital or acquired amputation in children.

Stump Overgrowth after Limb Amputation in Children

“…Stump overgrowth is the most common complication following limb amputation in children, and the incidence varies from 4 to 50% [2][3][4][5][6][7][8]. Age, location, reason for amputation, and level of amputation are known factors that affect the prevalence of stump overgrowth.…”

“…The goal was to convert a diaphyseal amputation into a stump resembling a disarticulation type, Figure 3. Many animal and human studies have been conducted to study the result of capping procedures using different materials, including 1 -biological caps: cancellous, cortical, and cartilaginous caps from the amputated distal stump and iliac crest; and Stump Overgrowth after Limb Amputation in Children DOI: http://dx.doi.org/10.5772/intechopen.90532 2 -synthetic caps: rubber, polyethylene, titanium, and Teflon caps [1,3,4,11,24,[26][27][28][29][30][31][32] (Table 1). Animal studies on rabbits, with transplantation of the metatarsal epiphyses and fixation to the end of the amputated bone, have shown epiphyseal capping to be a very successful procedure to prevent overgrowth [31].…”

“…Animal studies on rabbits, with transplantation of the metatarsal epiphyses and fixation to the end of the amputated bone, have shown epiphyseal capping to be a very successful procedure to prevent overgrowth [31]. Many further publications have shown capping of the stump with an osteochondral cap to be the most effective treatment, with a revision rate of 0-10% [4,29,32,33]. A controlled study compared osteochondral capping of the stump with simple resection and found a revision rate of 10% and, subsequently, of 86% [11,28].…”

“…The distal epiphysis of the amputated stump, distal tibia, distal ulna, head of the metatarsal bone, and calcaneus serve as donors for the osteochondral cap for primary amputation (amputation where a distal stump is available). Finding a donor for the osteochondral cap is a challenge in secondary amputation (revision cases and cases where the distal part is absent), and the proximal fibula of the ipsilateral knee can be used in these situations [4,29,31,33]. To avoid donor site morbidity (knee instability), Paley D used the apophysis of the iliac crest as a cap in a case series of patients [34].…”

Amputation and rotationplasty in children with limb deficiencies: Current concepts

“…When a transtibial amputation cannot be avoided, osseous overgrowth is a well-known problem. Different techniques have been developed to prevent an open marrow space at the end of the bone, with various degrees of success [23, 24]. Especially techniques that provide an osteocartilaginous ending to the end of the bone, such as, for example, transplanting a fibular head or a metatarsal head in the end of the tibia seem to decrease the percentage of overgrowth from 50% to around 0–10% [24].…”