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J Pediatr Orthop. 2009 Oct-Nov;29(7):726-9. doi: 10.1097/BPO.0b013e3181b726e1.

Angular deformity in pediatric transtibial amputation stumps.

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Shriners Hospitals for Children, Philadelphia, PA, USA.



Progressive angular deformity after surgical transtibial amputation in the pediatric population has not been described in the literature. Angular deformity in amputation stumps may lead to problems with pain and fitting of the prosthesis. The aim of this study was to evaluate the incidence and pattern of angular deformity and its treatment.


A retrospective review of 21 patients (24 limbs) with transtibial amputation was carried out. The mean age was 7.4 years (range: 1 to 18). There were 8 congenital and 13 acquired amputations (7 trauma, 4 infection, 1 tumor, 1 vascular). Sequential radiographs were evaluated for frontal and sagittal plane alignment. Deformity was defined as an angular deviation greater than 5 degrees.


Angular deformity was identified in 8 (38%) patients. Two patients had valgus deformity, 2 had varus deformity, and 1 had isolated recurvatum deformity. One patient had valgus procurvatum and 1 patient had varus recurvatum deformity. There was a mean stump revision rate of 1.38 in the congenital group and 0.85 in the acquired group. Three patients underwent deformity correction using an external fixator owing to difficulty with prosthetic fitting. All patients experienced improved fitting of their prosthesis after surgery.


Angular deformity can arise in children with transtibial amputations and may influence prosthesis fit and gait. Clinical and radiographic surveillance is important, and surgical correction may be of benefit. Surprisingly, stump revision rate was similar in both groups.

[Indexed for MEDLINE]

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