Iliac crest apophysis transfer to treat stump overgrowth after limb amputation in children: case series and literature review

Stump Overgrowth after Limb Amputation in Children

“…Finding a donor for the osteochondral cap is a challenge in secondary amputation (revision cases and cases where the distal part is absent), and the proximal fibula of the ipsilateral knee can be used in these situations [4,29,31,33]. To avoid donor site morbidity (knee instability), Paley D used the apophysis of the iliac crest as a cap in a case series of patients [34]. Bernd et al [27] studied the relationship between the revision rate in cartilaginous stump plasty and different factors and found no relationship with sex, reason for amputation, origin of the graft or method of fixation (screw vs. wires).…”

Unsuccessful Osteochondral Allograft Cap to Prevent Overgrowth in a Pediatric Patient with Previous Transtibial Amputation

“…He tolerated the procedure well for a year following surgery and was ambulating with a prosthesis for most of the day. However, he developed a symptomatic, bony recurrence at the end of his residual limb 13 months following the procedure, and we are planning for a revision amputation with iliac crest cartilaginous cap as described by Jahmani et al 10 In summary, we report the failure of an osteochondral allograft to prevent bony overgrowth at the time of revision transtibial amputation. Further studies on alternative graft options are warranted, particularly in patients with absence of the proximal fibula.…”

“…Simple resection has a high rate of recurrence with revision procedures performed in up to 87% of cases, leading to progressive shortening of the residual limb 13 . Similarly, proximal epiphysiodesis with preservation of excess distal soft tissue to alleviate theorized disproportionate bone and soft-tissue growth has been ineffective 1,5,10,14 . The use of skin flaps, bone grafts, calcaneocutaneous pedicle grafts, deinnervation of the residual limb, distal overgrowth synostosis, and the Ertl tibiofibular osteomyoplasty technique have also been attempted with mixed outcomes 2,7,10 .…”

“…To simulate a disarticulated amputation and prevent overgrowth, nonbiologic caps including rubber, silicon, polyethylene, Teflon, and titanium have been used with varied results 1 . Although synthetic caps can successfully reduce bony overgrowth, they have been associated with failure of fixation leading to infection, implant fracture, and subsequent pain with revision rates for polyethylene and Teflon caps as high as 70% and 29%, respectively 10 . While Teflon caps have failure rates similar to those of bone grafts, they are associated with more complications such as infection, inflammation, and painful bursa formation compared with other synthetic materials 1,2 .…”

“…In addition, the tight interference fit between the proximal fibula and the distal tibia reduces the need for augmented fixation, which has been a source of complications when managing overgrowth in transhumeral amputations 9 . However, this technique has its limitations in the setting of revision amputation and congenital absence of the fibula 2,10 . Problems with distal soft-tissue coverage, skin breakdown, and coronal plane instability have also been reported 2 .…”