Pediatric Amputations

Question 1

risser scale

Answer 1

uses standing AP radiographs to determine the progress of ossification of the Anterior Superior iliac spine

Question 2

transverse deficiency

Answer 2

limb developed typically to a particular level
skeletal elements do not exist past a certain level
distal buds may be present

Question 3

longitudinal deficiency

Answer 3

reduction or absence of an element occurs withtin the long axis of a alimb
skeletal elements may be present distal to the affected bones
named by describing bones in a proximal to distal sequence and states whether each affected bone is totally or partially absent

Question 4

proximal femoral focal deficiency

Answer 4

PFFD
absence or hypoplasia of the proximal femur
may include acetabulum, femoral head, patella, tibia, fibula
U/L or B/L

Question 5

proximal femoral focal deficiency
clinical manifestations

Answer 5

shortened thigh held in flexion, ABD, ER
Hip and knee contractures
Severe LLD

Question 6

causes of congential limb deficiencies

Answer 6

genetic
vascular (disruption of arterial flow)
teratogenic (thalidomide, contraceptives)
amniotic bands

Question 7

Which limb is often invloved with CLD?

Answer 7

upper limb

Question 8

most transverse deficiences are U/L or B/L?

Answer 8

U/L
rudimentary finger vestiges called ‘nubbins” can be present

Question 9

aquired amputations

trauma

Answer 9

trauma from machinery, power tools, MVA, gun shot, railroad
peak in summer/early fall

Question 10

acquired limb deficiencies

pathologies

Answer 10

ewing’s sarcoma and osteosarcoma

Question 11

Ewing sarcoma family of tumors

Answer 11

neuroepithelial tumors that involve both the bone and soft tissue
occur in flat and long bone, common in pelvis, ribs, femur, humerus, tibia
seen in peak growth rates

Question 12

osteosarcoma

Answer 12

primary malignant tumor of bone
occurs with growth spurt
located in metaphyseal portion of rapidly growing bone
* distal femur
* proximal tib
* proximal humerus

Question 13

Dx of osteosarcoma/ewing’s sarcoma

Answer 13

pain @ site of tumor
systemic symptoms common with ESFT
chronic pain with negative history of injury/trauma and w/o musculoskeltal abnormality
radiolgic eval
MRI
biopsy/histologic exam
CT scan

Question 14

what is an alternative to amputation in malignant tumors?

Answer 14

limb sparing or limb salvage procedures

Question 15

limb sparing or limb salvage procedures

Answer 15

involve resection of tumor and reconstruction of limb to preserve function
* use of excision of bone and replacement with allograft and endoprosthetic implant

Question 16

amputation

Answer 16

level of skeletal immaturity and future growth
physes preserved
terminal overgrowth of periosteum

Question 17

limb revisions purpose

Answer 17

done to perform fit or function of a prosthesis

Question 18

types of limb revisions

Answer 18

knee arthrodesis and amputation
limb lengthenening techniques and/or ephysiodesis of the involved or uninvolved limb
rotationplasty

Question 19

rotationplasty

Answer 19

for congenital limb deficiencies or w/ bony tumors
excision of distal femur/proximal femur
180° rotation of residual lower limb
preserves most of RL and NV supply

Question 20

benefits of rotationplasty

Answer 20

increased LL
imrpove prosthetic function (ankle serves as knee joint)
decrease in problems with bony overgrowth
decrease in pain from PL
allows for growth