Lengthening of a Very Short Below Knee Amputation Residual Limb to Enhance Prosthetic Wear

Summary

This patient underwent 8 cm lengthening of a dysfunctional very short below knee amputation (BKA) residual limb that was initially 7 cm in length. The lengthening was greater than 100% and resulted in a BKA residual limb of 15 cm. A prosthesis was attached to the circular external fixator allowing the patient to bear weight and walk during the treatment.

Pre-Op

The patient is a 27-year-old male who developed compartment syndrome after trauma 2 years earlier. This led to a BKA done at an outside medical center. The length of the tibial remnant was 7 cm. Although he was able to wear a prosthesis, he had difficulties related to the short residual limb.

Figure 1

Figure 2

Surgery

1. Lengthen residual tibia with goal to achieve length of 15 cm. Bone lengthening is done by cutting the tibia and distracting this 1 mm per day so new bone grows in the gap. After 2 months about half the length was achieved and the new bone was still immature (Figure 3). This called for an 8 cm lengthening (Figure 4) which more than double the starting tibial length.
2. Attach prosthesis to external fixator to enable the patient to bear weight. This was done right after surgery. The length was modified by changing the distance between the 2 blue rings (Figures 5 and 6).
    

Figure 3

Figure 4

Figure 5

Figure 6

Outcome

Figures 7A and 7B: AP and lateral x-rays 2 years after surgery. Note the well healed bone 15 cm in length without deformity. Flap coverage was performed by plastic surgeon to improve soft-tissue coverage of the residual limb.

Figure 7A

Figure 7B

Figures 8A and 8B: Clinical photos showing appearance and length of the residual limb. Prosthetic wear was improved with the lengthened residual leg.

Figure 8A

Figure 8B