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Journal of Pediatric Orthopedics Sep 2020Fibula hemimelia is the most common congenital deficiency of long bones. Primary treatment options include amputation with prosthetic fitting or limb reconstruction. The... (Meta-Analysis)
Meta-Analysis
PURPOSE
Fibula hemimelia is the most common congenital deficiency of long bones. Primary treatment options include amputation with prosthetic fitting or limb reconstruction. The aim of our study was to conduct a systematic review comparing amputation with limb reconstruction for fibula hemimelia.
METHODS
MEDLINE, EMBASE, Web of Science, Elsevier Scopus, and the Cochrane Registry of Clinical Trials were searched from 1951 to 2019 for studies that evaluated amputation versus limb reconstruction for fibula hemimelia. Random effect models were utilized for the meta-analytic comparisons of amputation versus limb reconstruction for patient satisfaction and surgical complications. Descriptive, quantitative, and qualitative data were extracted.
RESULTS
Seven retrospective cohort studies were eligible for the meta-analysis, with a total of 169 fibula hemimelia cases. Amputation resulted in an odds ratio of 6.8 (95% confidence interval: 2.4, 19.2) when compared with limb reconstruction in terms of patient satisfaction. Furthermore, limb reconstruction was found to have an odds ratio of 28 (95% confidence interval: 7.8, 100.3) for complications. The total surgical complication rates in the amputation and limb reconstruction groups were 0.2 and 1.2 complications per limb. The rate of surgical procedures per patient was 1.5 and 4.2 for amputation and limb reconstruction, respectively.
CONCLUSIONS
The cumulative evidence at present indicates better patient satisfaction with less surgical complications and less number of procedures with amputation for fibula hemimelia when compared with limb reconstruction. Absence of uniform protocols make it difficult to compare results accurately.
LEVEL OF EVIDENCE
Level III-therapeutic.
Topics: Amputation, Surgical; Ectromelia; Fibula; Humans; Outcome Assessment, Health Care; Patient Satisfaction; Postoperative Complications; Plastic Surgery Procedures
PubMed: 31972725
DOI: 10.1097/BPO.0000000000001510 -
Archives of Gynecology and Obstetrics Jul 2013Sirenomelia is caused by atrophy of the lower extremities that is commonly associated with gastrointestinal and urogenital malformations. (Review)
Review
Sirenomelia: a review on embryogenic enviromental theories, novel three-dimensional ultrasound imaging and first trimester diagnosis in a case of mosaic 69,XXX/46,XX fetus.
PURPOSE
Sirenomelia is caused by atrophy of the lower extremities that is commonly associated with gastrointestinal and urogenital malformations.
METHODS
Embryogenic environmental theories and systematic review of the literature are reported.
RESULTS
Genetic basis of the condition has been demonstrated in the animal model. In humans, association with de novo balanced translocation has only recently been documented.
CONCLUSIONS
A case of triploidy mosaic fetus with sirenomelia and posterior fossa anomaly diagnosed at first trimester using novel three-dimensional ultrasound imaging techniques is presented.
Topics: Adult; Animals; Chromosomes, Human, X; Cranial Fossa, Posterior; Ectromelia; Female; Humans; Imaging, Three-Dimensional; Mosaicism; Pregnancy; Pregnancy Trimester, First; Prognosis; Triploidy; Ultrasonography, Prenatal
PubMed: 23625330
DOI: 10.1007/s00404-013-2847-3