pediatric vs. adult amputations
- Children’s MS system continues to develop with growth
- Children are emotionally immature and dependent upon adults for care and decisions
causes of pediatric amputations
- Acquired (40%)
- Congenital (60%); Not as common anymore due to less use of teratogenic drugs; Limb buds are formed during first trimester (before 12 weeks)
congenital limb deficiencies
transverse and longitudinal
transverse congenital limb deficiency
- Normal development to a certain level with no skeletal elements existing below; with exception of digital buds
naming transverse congenital limb deficiency
- Named by the segment in which the limb terminates and then described at the level within the segment
- Example - upper arm middle third
longitudinal congenital limb deficiency
- Reduction or absence of parts of the long axis of the bone
- Normal bony parts may exist distal to the affected long axis
- Example - missing fibula, but foot is intact OR ulna and 4-5th fingers gone, but hand including thumb and 1-2nd fingers intact
naming longitudinal congenital limb deficiency
- Named by naming the bones affected in a proximal to distal sequence stating whether totally or partially absent
- Example - ulna middle third, carpals partial, phalange 1 total
acquired amputations
traumatic and disease-related
causes of traumatic amputations
Farm machinery, power tools, MVA, GSW, explosions, railroad accidents
disease-related amputations
sarcoma of the bone - osteosarcoma and ewing’s sarcoma
sarcoma of the bone red flags
pain not explained by MS problem, pain without recall of an injury, constant type, bone pain (deep type)
complications in pediatric amputations
- Osseous overgrowth (exostosis)
- Overgrowth of fibula
- Note: incidence common for both among children under 10 and traumatic amputations
surgical considerations
- Preservation of all possible epiphyses (longer residual limb)
- Disarticulation whenever possible
- Wound healing is rarely a concern
benefits of disarticulation amputations
- Preserves physes if possible
- Epiphyseal growth is preserved
- Terminal overgrowth is avoided
- Longer lever arm
- Suspension and rotational control are enhanced
- Residual limb tolerant to distal WB
limb lengthening
- Usually involves several surgeries
- Long recovery period
- Number of risk
- Can add up to 6 inches of length
- Ilizarov - most common procedure
limb replantation
- Goal - restore pain free function better than could be obtained with a prosthesis
- Rarely see phantom limb pain
phantom limb sensation in pediatrics
increases with age of child; typically not painful, but ability to more amputated limb
use and type of prosthesis dependent upon
- Family choice
- Child’s maturational level (physical and mental)
treatment considerations
- Standard prosthetics vs Non-standard prosthetics
- Growth - longitudinally and circumferentially
- Endo (pylo) vs exo-skeleton (cosmesis)
why use non-standard prosthesis
- When parents refuse or delay surgical conversion
- When it is necessary to sue the feet or hands for ADLs
- Prosthetics are as varied as residual limbs
how to accommodate growth longitudinally and circumferentially
- Start with added socks and distal pads
- Frequent follow-up
- Need to be reinforced for active childhood development and sports
UE prosthesis components
- Body powered or externally powered (myoelectric) or a combination
- Terminal device - “foot of the UE” = Passive hand, Hook (voluntary or closing), Myoelectric
- Suspension - harness or suction (typically only for young children)
LE prosthesis components
- Socket
- Suspension
- Knee (TF)
- Foot: SACH more common than energy-storing
when is the LE knee component introduced and why?
- not usually used in child until 2+ years (static knee instead)
- Can begin to control dynamic knee around 3 years
