Amputation for congenital pseudarthrosis of the tibia. Indications and techniques.

The indications for amputation with pseudarthrosis of the tibia are: failure of bony union after three surgical attempts; significant leg-length discrepancy; interference with growth distal to the pseudarthrosis; and a significant period under medical care, such that the patient suffers unduly. The primary problems related to amputating at the level of the pseudarthrosis are poor stump configuration, bony overgrowth, and poor skin coverage. A distal amputation at the ankle is recommended, using the technique for a cartilage-preserving Symes amputation. Methods for realigning the tibia at the time of amputation include the use of an intermedullary rod or a compression plate. The ultimate goal of treatment is always a functional limb.