Weinstein Lovell and Winters Pediatric Orthopaedics 7e

FIGURE 30-18. A–C : Pre-, intra-, and postoperative clinical photos of a patient with fibular deficiency undergoing Boyd amputation. Note the threaded Steinman pin protruding through the heel pad, which is used to fix the calcaneus to the distal tibia to promote fusion.

FIGURE 30-19. A : Anteroposterior radiograph of a type II fibular defi- ciency (Achterman and Kalamchi), in which the entire fibula is missing. Note the missing lateral rays of the foot and the severe angulation of the tibia. B,C : The limb, 6 weeks after Boyd amputation and an ante- rior closing-wedge osteotomy of the tibia. Placing the pin through the anterior cortex of the proximal fragment provides rigid fixation, which is not obtained if the pin is simply passed up the medullary canal. The pin was removed in the office at the time of cast removal. D,E : The clini- cal appearance of the same deficiency at the time of surgery in another patient. Note the short tibial segment, the valgus knee and foot, and the dimple over the tibia.