| Popis: |
To The Editor: We read with interest the article “Fibular Hemimelia: Comparison of Outcome Measurements After Amputation and Lengthening” (2000;82:1732-5), by McCarthy et al. The conclusion, “children who undergo early amputation for the treatment of fibular hemimelia are more active, have less pain, are more satisfied with the result of the treatment, have fewer complications, undergo fewer procedures, and incur less cost than those who undergo lengthening. . . . even though good results can be obtained with lengthening procedures,” warrants closer scrutiny. First, the number of patients who underwent limb-lengthening in this study is very small (eleven limbs in ten patients). Only six patients were treated with the Ilizarov method, and five were treated with the older Wagner method, which is associated with more complications and poorer results1. The mean age at the time of amputation was 1.2 years (range, seven months to 2.3 years) compared with a mean age of 9.7 years (range, 5.5 to 18.3 years) at the time of the initial lengthening procedure. The children in the lengthening group were followed until an average age of 16.8 years in comparison with the children in the amputation group, who were followed until an average age of 8.1 years. The patients in the lengthening group were therefore treated later, making treatment more difficult2, especially that involving large leg-length discrepancies that require as many as three lengthening procedures or two such procedures and one epiphysiodesis. It is more difficult to obtain and maintain correction of foot deformities that are not treated at an early age2. The two groups in the study by McCarthy et al. are therefore disparate; use of a case-matched control format would have produced a more scientifically valid study. When the children in the amputation group, who were followed until … |
