David E Westberry1, Jon R Davids, Linda I Pugh. 1. *Department of Pediatric Orthopaedic Surgery ‡Shriners Hospital for Children, Greenville, SC †Department of Orthopaedic Surgery, Motion Analysis Laboratory, Shriners Hospitals for Children, Sacramento, CA.
Abstract
BACKGROUND: The level of amputation in the pediatric population requires appropriate planning to provide an optimal residual limb for prosthetic fitting and must include long-term strategies to accommodate future growth of the extremity. METHODS: A retrospective review over a 15-year period was performed of all Boyd procedures (calcaneotibial fusion) in the pediatric limb deficiency population at a single institution. A chart review and radiographic analysis was performed to identify the indications, surgical outcomes, complications, need for additional surgical intervention, and nature of the postoperative prosthetic management. Optimal positioning of the calcaneotibial fusion and the growth-dependent changes in the morphology of the fusion site were determined by radiographic analysis. RESULTS: A total of 109 children (117 limbs) were identified for inclusion in the study. The average age at the time of the Boyd procedure was 2.8 years. The most common indication for the Boyd procedure was a diagnosis of postaxial limb bud deficiency, which accounted for 66% of cases. Concomitant procedures were performed in 24% of cases and included proximal tibial epiphyseodesis, tibial osteotomy, or knee fusion in the majority of cases. Additional procedures were required in 33% of cases either for treatment of complication (9%) or optimization of the residual limb (24%). For the entire cohort, the complication rate was 14%. Complications were most common when the Boyd procedure was used as a treatment strategy for congenital pseudoarthrosis of the tibia. Prosthetic management utilizing supramalleolar suspension with complete end-bearing through the residual limb was possible for the majority of cases. CONCLUSIONS: The Boyd procedure is an effective treatment for various conditions of the lower extremity. Concomitant or additional procedures after the initial intervention may be required for complete optimization of the residual limb. LEVEL OF EVIDENCE: Level IV.
BACKGROUND: The level of amputation in the pediatric population requires appropriate planning to provide an optimal residual limb for prosthetic fitting and must include long-term strategies to accommodate future growth of the extremity. METHODS: A retrospective review over a 15-year period was performed of all Boyd procedures (calcaneotibial fusion) in the pediatric limb deficiency population at a single institution. A chart review and radiographic analysis was performed to identify the indications, surgical outcomes, complications, need for additional surgical intervention, and nature of the postoperative prosthetic management. Optimal positioning of the calcaneotibial fusion and the growth-dependent changes in the morphology of the fusion site were determined by radiographic analysis. RESULTS: A total of 109 children (117 limbs) were identified for inclusion in the study. The average age at the time of the Boyd procedure was 2.8 years. The most common indication for the Boyd procedure was a diagnosis of postaxial limb bud deficiency, which accounted for 66% of cases. Concomitant procedures were performed in 24% of cases and included proximal tibial epiphyseodesis, tibial osteotomy, or knee fusion in the majority of cases. Additional procedures were required in 33% of cases either for treatment of complication (9%) or optimization of the residual limb (24%). For the entire cohort, the complication rate was 14%. Complications were most common when the Boyd procedure was used as a treatment strategy for congenital pseudoarthrosis of the tibia. Prosthetic management utilizing supramalleolar suspension with complete end-bearing through the residual limb was possible for the majority of cases. CONCLUSIONS: The Boyd procedure is an effective treatment for various conditions of the lower extremity. Concomitant or additional procedures after the initial intervention may be required for complete optimization of the residual limb. LEVEL OF EVIDENCE: Level IV.