Syme amputation for the treatment of fibular deficiency - An evaluation oflong-term physical and psychological functional status

Background: Syme amputation is an accepted treatment for fibular deficiency With improvement in limb-lengthening procedures, there has been renewed in terest in limb salvage for these patients. The purpose of the present study was to evaluate the physical and psychological results in ten young adults who had had a Syme amputation for the treatment of fibular deficiency when they mere children. Methods: The evaluation consisted of physical examination, prosthetic asses sment, psychological testing, and physical performance testing of knee exte nsion and flexion with use of a Cybex-II dynamometer, Results: Five patients reported no difficulty with the involved limb since the Syme amputation, four had had minor secondary procedures (three medial distal femoral or proximal tibial hemiepiphyseodeses, one reconstruction wi th an autologous patellar Ligament graft, one revision of the stump, and on e tibial osteotomy) on the affected extremity, and one had mild instability of the knee that had been treated nonoperatively All ten patients had an a ppropriate, functional Syme prosthesis, and none reported difficulty with w alking or running. On psychological testing, this group generally did not d iffer from the norm with regard to occupational satisfaction, personal grow th, relationships with family members and peers, and recreational behavior. The patients' overall assessment of self-reported quality of life and self -esteem was similar to that of normative adult samples. In general, these p atients were leading active, productive lives and had always done so. Conclusions On the basis of the results of this study we concluded that you ng adults who have had a Syme amputation apparently are not limited in thei r ability to pursue and achieve personal goals. in order to justify recomme nding limb salvage rather than early Syme amputation for the treatment of f ibular deficiency, the results of multistaged lengthening and reconstructio n would have to match the functional, psychological, and cost-effective res ults for the patients whom we studied, who had had a Syme amputation.