1
Q
Special Considerations for Children (3)
A
- Growth (overgrowth) (exostosis)
- Activity level (almost always K4)
- ROM and Joint stability
2
Q
Fibular Hemimelia
A
- AKA Longitudinal Fibular Deficiency
- Congenital Absence of all or some of the fibula
- Unstable Ankle often results in an elective Through Ankle Amputation
- less involved cases might Not Require amputation => Limb lengthening and Shoe Lift
- typical limb; Anterior Bowing, Dimple, Equinovalgus
- Shortened femur on affected side, Valgus @ knee
- proximal joints might be affected; Increased ROM @ hip, Laxity @ Knee
3
Q
Normal Developmental Landmarks for Gait
A
6 months - sits without support
9 months - crawls freely, pulls to stand
12 months - walks with assistance
15 months- walks without assistance
18 months - creeps backwards downstairs
21 months - walks up and down stairs
24 months - runs
3 years - stands on one leg
4 years - hops on one foot
4
Q
Why Choose Disarticulation vs. Transection in a Child (5)
A
- Epiphyseal growth is preserved
- Terminal overgrowth is avoided
- Longer lever arm is maintained
- Suspension and rotational control is enhanced
- Residual limb is tolerant to Distal weight bearing
5
Q
Psycho-social Considerations for Children (6)
A
- Children are less responsible and more mentally and emotionally immature
- Removable components will get lost
- Instructions forgotten or ignored
- Fitting problems not reported
- Children are dependent on adults
- Parental education is extremely important
- Rapidly changing goals
6
Q
PFFD (Proximal Femoral Focal Deficiency)
A
- congential anomaly characterized by a failure of normal development of the proximal end of the femur and also femoral joint
- 50% of cases are associated with fibular hemimelia
- typically thigh is held in flexion, abuduction, external rotation
- foot is at level of opposite knee
- treatment; limb lengthening and shoe lift, prosthesis (with or without surgery), van nes rotation
7
Q
Van Ness Rotationplasty
A
- surgical treatment for PFFD or Osteosarcoma
- rotation of foot 180 degrees so that ankle row functions as a knee and is fit with a BK prosthesis
- must require ischial weight bearing
- problems include; cosmesis, risk of surgery, eventual rotation of ankle
8
Q
Socket Designs to Allow for Growth (6)
A
- socket liners, easy to modify and protection
- '’slip’’ or ‘‘triple well’’ sockets, ability to remove inner layer
- more socks - arm for a looser initial fit
- distal pads- longitudinal and terminal growth
- can be removal and pre poured
- flexible sockets - heated and stretched
(use modular components)
9
Q
Longitudinal Deficiency
A
- there is a reduction or absence of an element or elements within the long axis of the limb
- there may be normal skeletal elements distal to the affected bones
- ie: longitudinal deficiency of the R fibula, proximal third
10
Q
Transverse Deficiency
A
- limb has developed normally to a level byeond which no skeletal elements exist
- described by naming segment where the limb terminated then describing level within segment beyond which no skeletal elements exist
- ie: transverse deficiency of the right radius and ulna, proximal third
11
Q
Constriction Band Syndrome
A
- AKA Streeter’s Dysplasia
- may cause amputation, webbing of fingers or toes (syndactyly)
- caused by a defection in the amnion (sac around the baby during pregnancy)
- fetal parts became entrapped in fibrous bands in utero
