Amputation

Indications 

1. Significant functional impairment

2. PIPJ contracture

- originally thought to intervene early

- Macfarlane showed residual FFD always about 30^o

- may need to release  check rein ligaments / accessory collateral ligaments

3. MCPJ contracture >30^o

4. Trigger fingers

- must do limited fasciectomy 

BKA / Below Knee Amputation / Transtibial

Best results

- long posterior musculocutaneous flap 

- well cushioned mobile muscle mass

- full thickness skin

- very anterior scar

Contraindication

- non-ambulator

- get FFD

- better with through knee amputation

Advantages over AKA 

1.  Good Healing 

Definition

Deficiency of bony elements on lateral side of lower limb

- characterised by hypoplastic or aplastic fibula

Types

Terminal

- abnormal foot

Intercalary

- normal foot

Epidemiology

Most common congenital deformity of long bones

- M:F   2:1

Definition

Paraxial deficiency of skeletal elements on medial aspect of lower limb

Epidemiology

Only skeletal deficiency with a documented familial occurrence 

- AD

1/ 1 000 000

Bilateral 30%

Clinical

Leg short +++