The Journal of Bone and Joint Surgery, Vol 73, Issue 6 858-867, Copyright © 1991 by Journal of Bone and Joint Surgery, Inc
Failure of centralization of the fibula for congenital longitudinal deficiency of the tibia
CH Epps, RE Tooms, CD Edholm, LM Kruger and DD Bryant
Handicapped and Crippled Children's Unit, District of Columbia General Hospital, Washington.
Between 1962 and 1983, fourteen patients (twenty knees) had centralization
of the fibula for congenital longitudinal deficiency: tibial, complete.
Eleven of the twenty index procedures were performed on patients who were
one year old or less. A progressive flexion deformity of the knee developed
after all twenty index procedures. Twenty-six secondary procedures were
needed, including disarticulation at the knee, posterior release, extension
osteotomy, femorofibular arthrodesis, and biceps-to-quadriceps transfer,
and one patient had a second attempt at centralization of the fibula. The
duration of follow-up after the initial centralization of the fibula ranged
from four years to twenty-two years and seven months (average, twelve years
and four months). Seven patients (eight limbs) in whom the index procedure
resulted in failure had a satisfactory result after disarticulation at the
knee. The patients who did not have secondary disarticulation at the knee
are also considered to have had a failed index procedure because they had a
flexion deformity at the latest follow-up. Attempts to reconstruct the knee
joint by centralization of the fibula are not warranted for patients who
have congenital longitudinal deficiency: tibial, complete. Early
disarticulation at the knee and fitting with a prosthesis, with close
follow-up, is the treatment of choice.
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