Acquired Amputation
account for 40% of all childhood amputations 70-85% attributed to trauma remainder are caused by disease 90% involve only 1 limb LE involved in 60% of cases
Traumatic Amputations
Males in adolescents = largest % of traumatic amputations in childhood
- Causes: farm machinery, power tools, MVA, gunshot wounds, railroad accidents
Amputations of Digits:
- children younger than 2 years d/t closing a door on a finger
Increased incidence of amputations in the summer months
- lawn mower- june
- farm machinery- september
Disease Related Amputation
Primary bone tumors account for 6% of cancers in children younger than 20 y/o
–Osteosarcoma and Ewing’s = most common bone tumors, 8.7 per million
Sarcoma of bone- primary malignant tumor of bone derived from bone forming mesenchyme in which the malignant proliferating spindle cell stroma produces osteoid tissue or immature bone.
- peak incidence coincides with puberty growth spurt
- occurs at metaphyseal portion of the most rapidly growing bones in adolescence
- M/c sites: distal femur, proximal tibia, proximal humerus
Ewing’s Sarcoma Family of Tumors- spectrum of neuroepithelial tumors ranging from undifferentiated round cell tumor of Ewing’s sarcoma of the bone to the neural differentiated peripheral primitive neuroectodermal tumor.
- Often involve both bone and soft tissue by the time of dx- including infiltration into medullary cavity an dbone marrow
- occurs in both flat and long bones
- primary sites are equally distributed between extremity and central axis sites
- M/c sites- pelvis, femur, ribs, humerus, tibia
- seen during times of peak times of growth , 50% dx btwn 10-20 y/o
Diagnosis- initial complaint of pain at the rise of the tumor with or without a palpable mass
- localized swelling or complaint of mass seen in osteosarcoma and ewing’s
- systemic symptoms rare in osteosarcoma unless have wide spread metastases
- -Ewing’s systemic symptoms- fever and weight loss
- Key to dx is radiographic evaluation, plain view, definitive dx may through biopsy and histologic exam, MRI, bone scan, CT
Medical Management of Malignancies
Surgery
Radiation
Chemo
Medical Mgmt of tumors and neoplasms is based on the following goals:
- complete and permanent control of the primary tumor
- control and prevention of mircostatic and metastatic disease
- preservation of fxn to the greatest degree possible
Local control of primary tumor often achieve through surgery and radiation therapy.
- Surgical- amputation or limb sparing
- – procedure depends on location and size of tumor , extramedullay extent, presence or absence of metastatic disease, child’s age and skeletal development
- mirco and metastatic controlled through radiation and chemo
Radiation
- Osteosarcoma unresponsive
- Ewing’s is highly responsive to radiation
- –Local control though high dose, however if tumor is greater than 8 cm must do whole bone radiation
- Side Effects- red/tender skin, mouth sores, nausea, vomiting, decreased activity level
- Late Side-effects- fibrosis of soft tissue, bony changes (osteoporosis to fractures), growth distrubances
- 77% of patients with Ewing’s treated with radiation have LLD
Chemo
- interfere with DNA and RNA, nonselective affecting both malignant and normal cells
- PT should be aware of what agents are being used to be aware of side effects
- Typical side effects: nausea, vomiting, hair loss, diarrhea, constipation, anemia, neutropenia, thrombocytopenia, neurological symptoms (neuropathies)
- Adjunctive chemo- given pre and post op has increased survival rate
Survival Rate: Depends on age, location, presence/location of metastasis
- Five year event-free survival- Ewing’s treated with combo of surgery/radiation/chemo in non-metastatic (60-70%)
- Osteosarcoma- 60-65% survival rate when treated with surgery and chemo
- –non metastatic of extremity more likely to have favorable outcome than children with more proximal tumors and presence of mets
