Ch 10- Peds: Limb Deficiencies Flashcards
What is a transverse limb deficiency?
No distal remaining portions
Named after the segment beyond which there is no skeletal portion
What is a longitudinal limb deficiency?
Have distal portions
Name the bones that are affected
What is Acheiria?
Missing hand or foot
What is Adactyly?
Absent metacarpal or metatarsal
What is Amelia?
Absence of a limb
What is Aphalangia?.
Absent finger or toe
What is Hemimelia?
Absence of half a limb
What is Meromelia?
Partial absence of a limb
What is Phocomelia?
Flipper-like appendage attached to the trunk
What are associated with limb deficiencies?
Craniofacial anomalies
What is TAR syndrome?
Thrombocytopenia with Absence of Radius
What is Faconi’s syndrome?
Anemia and leukopenia developing at 5 to 6 years of age
Upper extremity deficiency
What is Holt-Oram Syndrome?
Congenital heart disease, especially atrial septal defects and tetralogy of Fallot
Upper extremity deficiency
What is Baller-Gerold Syndrome?
Craniosynostosis
Upper extremity deficiency
What is VACTERL (or VATER) Syndrome?
Vertebral defects
Anal atresia
Cardiac defects
Tracheo Esophageal fistula
Renal dysplasia
Limb deficiency
What is the most common congenital limb deficiency?
Left terminal transradial deficiency
What should Prosthetic fitting should follow?
Attainment of normal developmental milestones, with the first fitting for a unilateral deficiency occurring when the child achieves sitting balance at around 6 to 7 months
What should the first upper extremity prosthetic a child has have?
Passive mitt in which the infant can practice placing objects
When should a more sophisticated prosthesis and terminal device be provided?
~ 11-13 months when the child begins to walk, performs simple grasp and release activities, and has an attention span >5 minutes
What is a Krukenberg procedure?
Reconstructs the forearm and creates a sensate prehensile surface for children with absent hands by separating the ulna and the radius in the forearm
What is a Vilkke procedure?
Attaches a toe to the residual limb
What is the most common congenital lower limb deficiency?
Fibular longitudinal deficiency (fibula hemimelia)
25% bilateral
What are Partial proximal femoral focal deficiency (PFFD) associated with?
70-80% associated with fibular deficiencies
What is a Van Ness Rotation?
Simulation of below-knee function by rotating the foot by 180° so ankle motion can control the prosthesis
When should a lower limb-deficient child be fit with a prosthesis?
When ready to pull up to standing position at 9 to 10 months
What type of prosthesis should a lower limb-deficient child be fit with for the first prosthesis?
Jointless, above-the-knee prosthesis to the toddler
When is a heel-to-gait established?
~2 years
When is a Prosthetic heel-strike to toe-off gait established?
~5 years or when the child can demonstrate sustained one-legged standing
When is a knee joint added to a prosthesis?
18 months of age
When is a suction socket prescribed?
Child can assist in donning a prosthesis, at about 5 years of age
What is the most common complication after amputation in the immature child?
Terminal overgrowth at the transected end of a long bone
Where is terminal overgrowth at the transected end of a long bone most common?
Humerus, fibula, tibia, and femur, in that order.
When are motorized WC used in limb deficiency?
5 to 6 years old, although, in exceptional cases, children as young as 20 months
Describe phantom limb sensation/pain in congenital limb deficiency.
Congenital limb-deficient children do not develop phantom sensation or pain even after conversion to surgical amputation of the limb
