BROWNS PROCEDURE FOR CONGENITAL ABSENCE OF THE TIBIA REVISITED

The results of reconstructive surgery in tibial hemimelia using a modi fied fibular transfer procedure as described by Brown were reviewed. A modified Brown's procedure was carried out on five patients with a to tal of seven affected limbs. A Syme's-type amputation of the foot was carried out in each case. All of the knees had quadriceps function pre operatively, which was considered a prerequisite for surgery. Average length of followup was 7 years, with a range of 2-12 years. The averag e age at time of surgery was 12.7 months, with a range of 7-26 months. At the time of review, all patients had reasonably good function of t heir lower extremities. All were ambulating with patellar tendon-beari ng prostheses and thigh extensions for collateral support. The average are of motion at review was 57.4 degrees, with further passive motion possible in all cases. Average extension was - 18.5 degrees, and the average active flexion was 76 degrees. We found that a fibular central ization procedure in a patient with at least grade III+ quadriceps fun ction can give good functional results that do not appear to deteriora te over time.