The Journal of Bone and Joint Surgery, Vol 72, Issue 9 1391-1399, Copyright © 1990 by Journal of Bone and Joint Surgery, Inc
Amputation or limb-lengthening for partial or total absence of the fibula
IH Choi, SJ Kumar and JR Bowen
Alfred I. duPont Institute, Wilmington, Delaware 19899.
Thirty-two patients who had ablation of the foot by the Syme or Boyd
technique for partial or total absence of the fibula, with subsequent
fitting of a prosthesis, were compared with eleven patients who had
lengthening of the lower limb by the Wagner method, to assess the long-term
results of each procedure. The final results were evaluated on the basis of
pain, limp, limb-length discrepancy, level of physical activity, and
satisfaction of the patient. Of the thirty-two patients who had an
amputation, twenty-eight (88 per cent) had a satisfactory result, compared
with only six (55 per cent) of the eleven patients who had
limb-lengthening. The amount of inequality between the lower limbs was
classified as follows: Group I--the foot of the shorter extremity was at
the distal third of the contralateral, normal limb, and the percentage of
shortening was 15 per cent or less; Group II--the foot of the shorter
extremity was at the level of the middle third of the contralateral, normal
limb, and the percentage of shortening was between 16 and 25 per cent; and
Group III--the foot of the shorter extremity was at the level of the
proximal third of the contralateral, normal limb, and the percentage of
shortening was greater than 26 per cent. Lengthening was best suited for
patients in Group I who had stable hips, knees, and ankles and a
plantigrade foot. Patients in Groups II and III were best served by
ablation of the foot and fitting of a prosthesis.
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