OPERATIVE TREATMENT OF BONE OVERGROWTH IN CHILDREN WHO HAVE AN ACQUIRED OR CONGENITAL AMPUTATION

Fifty-three children who were less than thirteen years old were follow ed for a median of seven years and ten months (range, two years and ni ne months to fourteen years and six months) after operative treatment for overgrowth of the tibia or humerus after amputation, During the th irty-one years in which these children were managed, three operative t echniques were used in successive periods, Thus, the fifty-three child ren could be divided into three groups: thirty-one who had had a resec tion and revision, nine in whom the bone had been capped with a synthe tic device, and thirteen in whom the bone had been capped with an auto genous tricortical bone graft from the iliac crest, A retrospective re view was performed to determine the result and complications associate d with each of these techniques. Survival analysis revealed that subse quent procedures were performed in twenty-six (84 per cent) of the thi rty-one patients who had had a resection and revision, in seven of the nine in whom the bone had been capped with a synthetic device, and in four of the thirteen in whom the bone had been capped with an autogen ous bone graft, The estimated mean survival time (that is, the time to a subsequent procedure) was five years in the group that had had the bone capped with an autogenous graft and three years and six months in the group that had had resection and revision; the difference is sign ificant (p = 0.003). The survival time in the group that had had a syn thetic device inserted was also less than that in the group that had h ad an autogenous graft (p = 0.07). Although an infection (four of the nine patients) or a fracture of the implant or bone (also four of the nine patients) developed in a larger proportion of patients in the gro up that had been managed,vith a synthetic tap than in the group that h ad been managed with an autogenous graft (one of thirteen for either c omplication), the numbers were too small for the differences to be sig nificant (p = 0.12). As a result of this study, we believe that applic ation of a cap consisting of autogenous bone graft from the iliac cres t is preferable to resection and revision or application of a syntheti c cap for treatment of established overgrowth of the bone in a patient who is less than thirteen years old.