Surgical capping proves safe, efficient for treatment of bony overgrowth

CLEARWATER BEACH, Fla. – Autologous osteocartilaginous capping using the proximal fibula is a safe technique for the management of long bone overgrowth in children with congenital and acquired pediatric amputation, according to data presented at the Association of Children’s Prosthetic-Orthotic Clinics Annual Meeting.

“The problem with previous literature on this topic is that this is a very uncommon condition with extremely low numbers of patients,” Graham Fedorak, MD, lead author of the study, said in the presentation. “Studies [thus far] have been very heterogeneous – mixing humeral overgrowth with femoral overgrowth, with tibiae overgrowth. So, our objective was to review the results of all patients treated for terminal bony overgrowth.”

Graham Fedorak


Fedorak and a team of researchers at the Shriners Hospital for Children in Los Angeles, examined 50 tibiae in 47 patients from a single pediatric hospital, and compared patients with acquired and congenital amputations. The mean age at surgery was 7.6 years and mean follow up time was 7.2 years. Data was collected from 1990 to 2011.

Findings showed no significant difference between children with acquired or congenital amputation. Findings also showed that in 50 tibiae, the rate of recurrent overgrowth was 10% after capping, the rate of reoperation for any reason was 18% and the rate of complications was 22%.

“Those numbers may sound high, but they compare very favorably with other surgical strategies,” Fedorak said. “So in conclusion, osteocartilaginous transfer of the proximal fibula has been a very effective treatment for this type of overgrowth.” – by Shawn M. Carter


Fedorak. Paper #1. Presented at: Association of Children’s Prosthetic-Orthotic Clinics Annual Meeting; May. 13-16, 2015; Clearwater Beach, Fla.

Disclosure: Fedorak reports no relevant financial disclosures.

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