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Surgical Technique for Varus Deformity Correction of Below-Knee Stump in a Paediatric Patient

Paediatric amputation is one of the treatment options for various indications, namely, trauma, infection, tumour and congenital problems, and some may be born with congenital problems. It differs from adult amputation as they have higher physical demands, and special complications may arise. Stump o...

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Autores principales: Nik Abdul Adel, Nik Alyani, Abdul Razak, Ardilla Hanim, Sri Ramulu, S Suresh, Awang, Mohd Shukrimi
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Cureus 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10544382/
https://www.ncbi.nlm.nih.gov/pubmed/37791173
http://dx.doi.org/10.7759/cureus.44477
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author Nik Abdul Adel, Nik Alyani
Abdul Razak, Ardilla Hanim
Sri Ramulu, S Suresh
Awang, Mohd Shukrimi
author_facet Nik Abdul Adel, Nik Alyani
Abdul Razak, Ardilla Hanim
Sri Ramulu, S Suresh
Awang, Mohd Shukrimi
author_sort Nik Abdul Adel, Nik Alyani
collection PubMed
description Paediatric amputation is one of the treatment options for various indications, namely, trauma, infection, tumour and congenital problems, and some may be born with congenital problems. It differs from adult amputation as they have higher physical demands, and special complications may arise. Stump overgrowth by far is the commonest complication in paediatric transosseous amputation, while varus deformity of the tibia stump was reported sparsely in the literature. The growth discrepancy of the proximal tibia and fibula physis coupled with distal tibiofibular synostosis may have resulted in proximal migration of the fibula, which later resulted in varus deformity of the stump. This will cause difficulty in prosthesis fitting and lead to painful stumps due to the pressure at the abnormal bony prominence. We report a case of congenital limb deficiencies in a 12-year-old male who was treated with below-knee amputation (BKA) and experienced progressive varus deformity of the stump that caused pain during prosthetic wear, which interfered with his gait. He had a varus deformity of 15 degrees of the stump, distal tibiofibular synostosis and proximal migration of the fibula head. As the conservative management by modification of the prosthesis had failed, he underwent open wedge proximal tibia corrective osteotomy, division of the synostosis and reduction of the fibula head. The surgical intervention was successful in alleviating his problem. All efforts must be made to ensure optimum prosthetic fitting in paediatric amputation patients to maintain the patient’s daily lifestyle and activities.
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spelling pubmed-105443822023-10-03 Surgical Technique for Varus Deformity Correction of Below-Knee Stump in a Paediatric Patient Nik Abdul Adel, Nik Alyani Abdul Razak, Ardilla Hanim Sri Ramulu, S Suresh Awang, Mohd Shukrimi Cureus Physical Medicine & Rehabilitation Paediatric amputation is one of the treatment options for various indications, namely, trauma, infection, tumour and congenital problems, and some may be born with congenital problems. It differs from adult amputation as they have higher physical demands, and special complications may arise. Stump overgrowth by far is the commonest complication in paediatric transosseous amputation, while varus deformity of the tibia stump was reported sparsely in the literature. The growth discrepancy of the proximal tibia and fibula physis coupled with distal tibiofibular synostosis may have resulted in proximal migration of the fibula, which later resulted in varus deformity of the stump. This will cause difficulty in prosthesis fitting and lead to painful stumps due to the pressure at the abnormal bony prominence. We report a case of congenital limb deficiencies in a 12-year-old male who was treated with below-knee amputation (BKA) and experienced progressive varus deformity of the stump that caused pain during prosthetic wear, which interfered with his gait. He had a varus deformity of 15 degrees of the stump, distal tibiofibular synostosis and proximal migration of the fibula head. As the conservative management by modification of the prosthesis had failed, he underwent open wedge proximal tibia corrective osteotomy, division of the synostosis and reduction of the fibula head. The surgical intervention was successful in alleviating his problem. All efforts must be made to ensure optimum prosthetic fitting in paediatric amputation patients to maintain the patient’s daily lifestyle and activities. Cureus 2023-08-31 /pmc/articles/PMC10544382/ /pubmed/37791173 http://dx.doi.org/10.7759/cureus.44477 Text en Copyright © 2023, Nik Abdul Adel et al. https://creativecommons.org/licenses/by/3.0/This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Physical Medicine & Rehabilitation
Nik Abdul Adel, Nik Alyani
Abdul Razak, Ardilla Hanim
Sri Ramulu, S Suresh
Awang, Mohd Shukrimi
Surgical Technique for Varus Deformity Correction of Below-Knee Stump in a Paediatric Patient
title Surgical Technique for Varus Deformity Correction of Below-Knee Stump in a Paediatric Patient
title_full Surgical Technique for Varus Deformity Correction of Below-Knee Stump in a Paediatric Patient
title_fullStr Surgical Technique for Varus Deformity Correction of Below-Knee Stump in a Paediatric Patient
title_full_unstemmed Surgical Technique for Varus Deformity Correction of Below-Knee Stump in a Paediatric Patient
title_short Surgical Technique for Varus Deformity Correction of Below-Knee Stump in a Paediatric Patient
title_sort surgical technique for varus deformity correction of below-knee stump in a paediatric patient
topic Physical Medicine & Rehabilitation
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10544382/
https://www.ncbi.nlm.nih.gov/pubmed/37791173
http://dx.doi.org/10.7759/cureus.44477
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