A review of the aetiological factors and results of trans-ankle (Syme) disarticulations.

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Abstract

[Indexed for MEDLINE] 17. RETRACTED ARTICLE J Foot Ankle Surg. 2017 Sep-Oct;56(5):1121-1124. doi: 10.1053/j.jfas.2017.04.023. Epub 2017 Jun 13. Amniotic Band Syndrome With Pseudoarthrosis of Tibia and Fibula: A Case Report. Ananthan A(1), Athalye Jape G(2), Du Plessis J(2), Annear P(3), Page R(4), Rao S(5). Author information: (1)Senior Resident, Department of Neonatal Paediatrics, Princess Margaret Hospital for Children, Perth, Western Australia, Australia. Electronic address: ani.gem81@gmail.com. (2)Assistant Professor, Department of Neonatal Paediatrics, Princess Margaret Hospital for Children, Perth, Western Australia, Australia. (3)Orthopaedic Surgeon, Department of Orthopaedics, Princess Margaret Hospital for Children, Perth, Western Australia, Australia. (4)Plastic Surgeon, Department of Plastic Surgery, Princess Margaret Hospital for Children, Perth, Western Australia, Australia. (5)Associate Professor, Centre for Neonatal Research and Education, University of Western Australia, Crawley, Western Australia, Australia. Retraction in J Foot Ankle Surg. 2018 Mar - Apr;57(2):432. doi: 10.1053/j.jfas.2017.12.014. Constriction of the lower limb by a congenital amniotic band has been proposed to explain the development of pseudoarthrosis of the tibia and fibula. We report a case of amniotic band syndrome in a preterm female infant with pseudoarthrosis of the tibia and fibula. She was born at 29 weeks of gestation with congenital amniotic bands and was noted to have a severely edematous left foot distal to the constricting band with rudimentary digits. The skin was pink and well perfused with palpable pulses. Radiography demonstrated pseudoarthrosis of the tibia and fibula. The limb deformities were managed with splints, positioning, and physiotherapy. She underwent Z-plasty with soft tissue release on the left lower leg on day 7 of life. At 36 weeks of postmenstrual age, a repeat radiograph showed markedly improved growth of the tibia and fibula with mature new bone formation, which avoided the need for further surgical intervention. During the follow-up period, she underwent left Syme's amputation at 18 months. At 29 months of age, the child was able to walk and run without support. The findings from our case confirm the potential for bone growth in patients with amniotic band syndrome, once the constricting band has been released. Simple release of the constriction band with Z-plasty resulted in growth of mature bone, replacing the pseudoarthrosis and, hence, the patient did not require surgical amputation. Thus, one should be cautious when deciding on surgical amputation, even in the presence of pseudoarthrosis, especially in preterm infants. Early limb-preserving surgery with release of the constricting band with an intention to salvage the limb appears appropriate. Copyright © 2017 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved. DOI: 10.1053/j.jfas.2017.04.023