Brown's Procedure for Congenital Absence of the Tibia Revisited

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SummaryThe results of reconstructive surgery in tibial hemimelia using a modified fibular transfer procedure as described by Brown were reviewed. A modified Brown's procedure was carried out on five patients with a total of seven affected limbs. A Syme's-type amputation of the foot was carried out in each case. All of the knees had quadriceps function preoperatively, which was considered a prerequisite for surgery. Average length of follow-up was 7 years, with a range of 2-12 years. The average age at time of surgery was 12.7 months, with a range of 7-26 months. At the time of review, all patients had reasonably good function of their lower extremities. All were ambulating with patellar tendon-bearing prostheses and thigh extensions for collateral support. The average arc of motion at review was 57.4°, with further passive motion possible in all cases. Average extension was -18.5°, and the average active flexion was 76°. We found that a fibular centralization procedure in a patient with at least grade III+ quadriceps function can give good functional results that do not appear to deteriorate over time.

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