TITLE

Adult Outcomes Following Amputation or Lengthening for Fibular Deficiency

AUTHOR(S)
Walker, Janet L.; Knapp, Dwana; Minter, Christin; Boakes, Jennette L.; Salazar, Juan Carlos; Sanders, James O.; Lubicky, John P.; Drvaric, David M.; Davids, Jon R.
PUB. DATE
April 2009
SOURCE
Journal of Bone & Joint Surgery, American Volume;Apr2009, Vol. 91-A Issue 4, p797
SOURCE TYPE
Academic Journal
DOC. TYPE
Article
ABSTRACT
Background: Fibular deficiency results in a small, unstable foot and ankle as well as a limb-length discrepancy. The purpose of this study was to assess outcomes in adults who, as children, had had amputation or limb-lengthening, commonly used treatments for fibular deficiency. Methods: Retrospective review of existing data collected since 1950 at six pediatric orthopaedic centers identified 248 patients with fibular deficiency who were twenty-one years of age or older at the time of the review. Excluding patients with other anomalies and other treatments (with the excluded group including six who had had lengthening and then amputation), we identified ninety-eight patients who had had amputation or limb-lengthening for the treatment of isolated unilateral fibular deficiency. Sixty-two patients (with thirty-six amputations and twenty-six lengthening procedures) completed several questionnaires, including one asking general demographic questions, the Beck Depression Inventory-II, the Quality of Life Questionnaire, and the American Academy of Orthopaedic Surgeons Lower Limb Questionnaire including the Short Form-36. A group of twenty-eight control subjects completed the Beck Depression Inventory-II and the Quality of Life Questionnaire. Results: There were forty men and twenty-two women. The average age at the time of the interview was thirty-three years. There were more amputations in those with fewer rays and less fibular preservation. Lengthening resulted in more surgical procedures (6.3 compared with 2.4 in patients treated with amputation) and more days in the hospital (184 compared with sixty-three) (both p <0.0001). However, when we compared treatment outcomes we did not find differences between groups with regard to education, employment, income, public assistance or disability payments, pain or use of pain medicine, sports participation, activity restriction, comfort wearing shorts, dislike of limb appearance, or satisfaction with treatment. No patient who had been treated for fibular deficiency reported signs of depression. The only significant difference between treatment groups shown by the Quality of Life Questionnaire was in the scores on the Job Satisfiers content scale, with the amputees scoring better than the patients treated with lengthening (p = 0.015). The American Academy of Orthopaedic Surgeons Lower Limb Module did not demonstrate differences in health-related quality of life or physical function. Conclusions: The patients who were treated with lengthening had started out with more residual foot rays and more fibular preservation than the amputees. They also required more surgical intervention than did those with an amputation. While patients with an amputation spent less of their childhood undergoing treatment, they were found to have a better outcome in terms of only one of seventeen quality-of-life parameters. Both groups of patients who had had treatment of fibular deficiency were functioning at high levels, with an average to above-average quality of life compared with that of the normal adult population. Level of Evidence: Therapeutic Level III. See Instructions to Authors for a complete description of levels of evidence.
ACCESSION #
37614968

 

Related Articles

  • Alargamiento óseo en pacientes con hemimelia peronea. Galindo, Mauricio Montalvo; Zacarías, Nelson Cassis; Nasser, Alberto Harfush; Franco, Luis Camacho; Ramírez, Alejandro Rivera // Acta Ortopedica Mexicana;may/jun2005, Vol. 19 Issue 3, p99 

    Background. Fibular hemimelia Achterman-Kalamchi type II is a rare congenital deficiency and it may be associated with other deformities. Treatment includes amputation or leg lengthening. There are many studies that document the success of both procedures. The purpose of our study is to present...

  • Chronic Wounds: Combating an "Axis of Evil" with the "Forces of Healing.". Rogers, Lee C.; Bevilacqua, Nicholas J.; Armstrong, David G. // Podiatry Management;Nov/Dec2007, Vol. 26 Issue 9, p91 

    The article discusses various ways to combat chronic wounds and prevent amputation. It suggests that a patient with a lower extremity wound and peripheral ischemia should consult a physician for a vascular intervention. It states that a tendon-Achilles lengthening has been shown to minimize...

  • Bilateral tibial lengthening over the nail: our experience of 143 cases. Motallebi Zadeh, Nader; Mortazavi, Seyedeh; Khaki, Siavash; Heidari, Kazem; Karbasi, Ashraf; Ostad Rahimi, Sedigheh // Archives of Orthopaedic & Trauma Surgery;Sep2014, Vol. 134 Issue 9, p1219 

    Introduction: Using lengthening over an intramedullary nail as a technique for cosmetic purposes improves the individuals' quality of life and provides more satisfactory results due to less external fixator period. Methods: This study reports a case series of 143 individuals who underwent...

  • Recurrence of diabetic pedal ulcerations following tendo-Achilles lengthening. Weiner, Richard D.; Hlad, Lee M.; McKenna, Danielle R. // Diabetic Foot & Ankle;2011, Vol. 2, p1 

    Foot and ankle surgeons are frequently challenged by the devastating systemic consequences of diabetes mellitus manifested through neuropathy, integumentary and joint breakdown, delayed healing, decreased ability to fight infection, and fragile tendon/ligaments. Diabetic neuropathic pedal...

  • Fibular Hemimelia: Comparison of Outcome Measurements After Amputation and Lengthening. McCarthy, James J.; Glancy, Gerald L.; Chang, Frank M.; Eilert, Robert E. // Journal of Bone & Joint Surgery, American Volume;Dec2000, Vol. 82-A Issue 12, p1732 

    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...

  • Acute Shortening and Delayed Lengthening in Management of Lower Leg Amputation: A Case Report. Seung Hoon Kang; Sung Won Jung; Jin Woo Jin; Dong Hee Kim; Sung Jin Shin; Min Jeong; Yil Ju Eho // Archives of Reconstructive Microsurgery;Nov2016, Vol. 25 Issue 2, p65 

    Acute bone shortening and delayed lengthening by Ilizarov surgery have been used to treat a wide range of soft tissue injuries including open fracture, osteomyelitis of the tibia and lower leg amputation. It has advantages such as bone lengthening as well as minimizing the loss of damaged...

  • Subjective well-being and age. Horley, James; Lavery, J. John // Social Indicators Research;Feb95, Vol. 34 Issue 2, p275 

    Presents two studies concerning the relationship between subjective well-being and age. Positive association between well-being and age; Differential age experiences and access to available resources; Reflection of stability of a personality trait in individuals.

  • Effects of intellectual variables, age, and gender on divergent thinking in adulthood. Reese, Hayne W.; Lee, Liang-Jei; Cohen, Stanley H.; Puckett Jr, James M. // International Journal of Behavioral Development;Nov2001, Vol. 25 Issue 6, p491 

    Divergent thinking was assessed in 400 adult women and men with tests of word association (associational fluency) and alternate uses (production fluency, flexibility, and originality). The participants were from four age cohorts: young (17-22 years old), middle-aged (40-50), young-old (60-70),...

  • Young survivors of malignant bone tumours in the extremities: a comparative study of quality of life, fatigue and mental distress. Liv Aksnes; Kirsten Hall; Nina Jebsen; Sophie Fosså; Alv Dahl // Supportive Care in Cancer;Sep2007, Vol. 15 Issue 9, p1087 

    Abstract Purpose  The purpose of the study was to compare the quality of life (QoL), fatigue and mental distress in survivors of malignant extremity bone tumours (EBT survivors) with age and gender-matched survivors of Hodgkin’s disease (HD survivors) and testicular cancer (TC...

Share

Read the Article

Courtesy of VIRGINIA BEACH PUBLIC LIBRARY AND SYSTEM

Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics