Background: Treatment of fibular hemimelia
includes either Syme or Boyd amputation with early prosthetic fitting
or tibial lengthening. Numerous studies have documented the success
of both procedures. The purpose of our study was to compare the
outcome after amputation with that after tibial lengthening, specifically
with regard to activity restrictions, pain, satisfaction, complications, number
of procedures, and cost, in children with fibular hemimelia.
Methods: Thirty limbs in twenty-five patients
treated with either an amputation or a lengthening procedure and
followed for at least two years were studied. Fifteen patients underwent
amputation, and ten patients underwent lengthening of the tibia.
The mean age was 1.2 years at the time of amputation and 9.7 years
at the time of initial lengthening. The mean duration of follow-up
was 6.9 years after the amputations and 7.1 years after the lengthening procedures.
Results: The patients who underwent amputation
were able to perform more activities than those who had a lengthening
(mean activity score, 0 compared with 1.2 points; p < 0.05),
and they had less pain (mean pain score, 0.2 compared with 1.2 points;
p = 0.091), were more satisfied and had a lower complication rate
(0.37 compared with 1.91; p < 0.05). The patients who underwent
amputation also had fewer procedures (1.9 compared with 7.0; p < 0.05),
at a lower cost ($7016 compared with $26,900; p < 0.05), than
those who had a lengthening. Lengthening was successful in equalizing limb
lengths; the mean limb-length discrepancy, assessed in nine of eleven
limbs, was 0.7 centimeter.
Conclusions: This study demonstrated that children
who undergo early amputation are more active, have less pain, are
more satisfied, have fewer complications, undergo fewer procedures,
and incur less cost than those who undergo lengthening. This was
true even though good results were obtained with the lengthening
procedures and most patients achieved limb-length equality, were
able to walk, had minimal pain, and were quite active.