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CHAPTER 30
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The Child with a Limb Deficiency
should be used first unless a bony spike is felt. If revision sur-
gery is necessary, a capping procedure should be considered.
In the case of a primary amputation, it is advisable to use
available parts from the amputated portion of the limb to
cap the end of the bone, if conditions permit. The most com-
mon procedure is the use of the proximal fibula to cap the
tibia (Figs. 30-3A–E). As in any revision, adequate resection
of the bone is essential to provide a healthy soft-tissue enve-
lope. Harvest of the proximal fibula involves detaching the
lateral collateral ligament of the knee, which can theoretically
lead to lateral knee instability. However, there have been no
reports of lateral knee instability after proximal fibular resec-
tion for biologic capping, and the literature regarding knee
instability after proximal fibular resection for tumors is mixed
(50–54). Given that the literature is unclear on the need for
lateral ligamentous reconstruction, it seems reasonable to test
intraoperative knee instability and repair or reconstruct the
ligament if necessary.
FIGURE 30-2.
A–C
: Clinical photos and AP radiograph of the tibia exhibiting bony overgrowth and ulcer formation.
FIGURE 30-3.
A–D
: Intraoperative pho-
tos demonstrating proximal fibular harvest
and subsequent insertion of the proximal
fibula in the medullary canal of the tibia
(modified Marquardt procedure).
E
: AP radio-
graphic appearance of the tibia 6 weeks
after the procedure.
