The use of vascularised bone capping to prevent and treat amputation stump spiking in the paediatric population

Murphy, Anthony B.; Atkins, Sara E.; Thomas, Damon J.; McCombe, David; Coombs, Christopher J.

doi:10.1002/micr.30160

Cited by 4 publications

(3 citation statements)

References 22 publications

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“…For children with limb deficiencies, particularly transtibial amputations, stump overgrowth can be a painful barrier to athletic participation. Surgical treatment may be considered and can include distal stump resection, with capping of the tibia with an osseocartilaginous graft 98,99 . When any surgical intervention is considered for a patient with a limb deficiency, close collaboration with a prosthetist is necessary to understand the optimal limb length and amputation level needed for prosthetic function.…”

Section: Limb Deficienciesmentioning

confidence: 99%

Parasport: Effects on Musculoskeletal Function and Injury Patterns

Sacks

Carter

et al. 2022

Journal of Bone and Joint Surgery

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ä Sports participation can improve gait, muscle strength, and functional abilities in patients with a wide variety of disabilities. Para athletes are also at substantial risk for injury during sports participation.ä Ambulant athletes with cerebral palsy are at risk for soft-tissue injuries about the knee as well as foot and ankle injuries. Wheelchair athletes are at risk for osteoporotic fractures and shoulder girdle injuries. Limb-deficient athletes are prone to low back pain and overuse injuries of the contralateral extremity.ä Para athletes are vulnerable to abuse during sports participation, and physicians should promptly report any possible abuse or mistreatment.ä Orthopaedic surgeons should understand disability and sport-specific risk factors for injury in para athletes in order to initiate early management and injury prevention protocols.Disclosure: The Disclosure of Potential Conflicts of Interest forms are provided with the online version of the article (http://links.lww.com/JBJS/H136).

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Section: Limb Deficienciesmentioning

confidence: 99%

Parasport: Effects on Musculoskeletal Function and Injury Patterns

Sacks

Carter

et al. 2022

Journal of Bone and Joint Surgery

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“…Age, sex, location (diaphysis, metaphysis, or epiphysis), as well as type and cause of amputation (traumatic or elective) influence the incidence of overgrowth 1,2 . Specifically, overgrowth is rare after skeletal maturity and more prevalent after amputations through the humerus and tibia while it is rarely encountered after transradial and transmetatarsal amputations [2][3][4][5] . Bony overgrowth is rare in congenital agenesis but common in amnionic band syndrome and traumatic amputations.…”

mentioning

confidence: 99%

“…Bony or residual limb overgrowth after pediatric amputations is the most common complication and has been reported in up to 50% of cases 1,2 . Its pathogenesis is not well-understood and often leads to postoperative complications, including chronic pain, skin ulceration, perforation, infection, swelling, erythema, and prosthetic discomfort, all of which may require surgical revision 2,3 . Age, sex, location (diaphysis, metaphysis, or epiphysis), as well as type and cause of amputation (traumatic or elective) influence the incidence of overgrowth 1,2 .…”

mentioning

confidence: 99%

Unsuccessful Osteochondral Allograft Cap to Prevent Overgrowth in a Pediatric Patient with Previous Transtibial Amputation

Pluta

Harrington

Smith

et al. 2023

JBJS Case Connector

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Case: This case demonstrates the attempted utilization of an osteochondral allograft for the prevention of bony overgrowth in a patient with fibular hemimelia and previous transtibial amputation with failure of Teflon capping. Additionally, we describe a novel technique to provide additional padding and increase the width of the residual limb using a dermal allograft.Conclusions: Bony overgrowth after pediatric amputations is common and often necessitates revision procedures secondary to infection, ulceration, pain, and discomfort with prosthesis use. Our use of an osteochondral allograft cap to prevent bony overgrowth ultimately failed 13 months following the procedure, and further research on various graft options and other treatment modalities is warranted, especially if the proximal fibula is unavailable or there is concern for donor site morbidity associated with harvesting autologous grafts.Disclosure: The Disclosure of Potential Conflicts of Interest forms are provided with the online version of the article (http://links.lww.com/JBJSCC/C41).

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