Fibular hemimelia: Comparison of outcome measurements after amputation andlengthening

Background: Treatment of fibular hemimelia includes either Syme or Boyd amp utation with early prosthetic fitting or tibial lengthening. Numerous studi es have documented the success of both procedures. The purpose of our study was to compare the outcome after amputation with that after tibial lengthe ning, specifically with regard to activity restrictions, pain, satisfaction , complications, number of procedures, and cost, in children with fibular h emimelia. Methods Thirty limbs in twenty-five patients treated with either an amputat ion or a lengthening procedure and followed for at least two years were stu died. Fifteen patients underwent amputation, and ten patients underwent len gthening of the tibia. The mean age was 1.2 years at the tine of amputation and 9.7 years at the time of initial lengthening. The mean duration of fol low-up was 6.9 years after the amputations and 7.1 years after the lengthen ing procedures. Results: The patients who underwent amputation were able to perform more ac tivities 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 co mpared with 1.2 points; p = 0.091), were more satisfied and had a lower com plication rate (0.37 compared with 1.91; p < 0.05). The patients who underw ent 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 ha d a lengthening. Lengthening was successful in equalizing limb lengths; the mean limb-length discrepancy, assessed in nine of eleven limbs, was 0.7 ce ntimeter, Conclusions This study demonstrated that children who undergo early amputat ion are more active, have less pain, are more satisfied, have fewer complic ations, undergo fewer procedures, and incur less cost than those who underg o lengthening. This was true even though good results were obtained with th e lengthening procedures and most patients achieved limb-length equality, w ere able to walk, had minimal pain, and were quite active.