Weinstein Lovell and Winters Pediatric Orthopaedics 7e

1550

CHAPTER 30  |  The Child with a Limb Deficiency

FIGURE 30-17.  In many cases of fibular deficiency, the tibia is bowed anteriorly. Although this does not cause a problem with prosthetic fitting during the child’s younger years, it may worsen with growth, making both prosthetic fitting and align- ment of the foot difficult later. If it appears that this deformity will be significant, it is best to correct it at the same time as the amputation (Syme or Boyd) because it does not delay fitting significantly and at this age is preferable to a tibial osteotomy in later childhood. A straight incision is made directly over the subcutaneous border of the tibia at the apex of the bow and carried directly down through the periosteum (A) . A small area of the tibia is exposed subperiosteally, leaving the posterior periosteum intact. A saw or rongeur is used to remove a small wedge of bone in the appropriate plane to correct the defor- mity. Usually this is not a straight anterior bow (B) . A Steinmann pin is passed through the heel pad, through the calcaneus, into the distal fragment of the tibia, and then into the proximal fragment of the tibia. The wounds are then closed (C) .