Limb Deficiencies Flashcards
When during gestation do limb deficiencies occur?
during formation of the limb from day 26 to 8 weeks
What are three medications linked to congenital limb deficiency?
thalidomide, retinoid acid, and misoprostol
What is the preferred classification system for congenital limb deficiencies?
ISPO (International Society for Prosthetics and Orthotics)
What is a transverse deficiency?
Deficiency with no distal remaining portions
What is a longitudinal deficiency?
Deficiency with distal remaining portions
How are longitudinal deficiencies named?
They are named for the bones that are affected. Any bone not named is present and of normal form.
How are transverse deficiencies named?
It is named after the segment beyond which there is no skeletal portion
What is acheiria?
missing hand or foot
What is adactyly?
absent metacarpal or metatarsal
What is amelia?
absence of a limb
What is hemimelia?
presence of half a limb
What is phocomelia?
“seal limb”: hypoplastic proximal limb with near normal hand or foot
What is meromelia?
partial absence of a limb
What other anomalies are associated with limb deficiencies?
craniofacial
What is the most common congenital limb deficiency?
left terminal transradial
When should fitting for a unilateral upper limb deficiency take place?
When a child achieves sitting balance
When should a child transition from a passive upper limb prosthesis to one that can grasp and release?
When the child begins to walk and has an attention span > 5 minutes
What is the Krukenberg procedure?
creation of a prehensile surface for children with absent hands by separating the radius and ulna
Which gross motor activity is more difficult with a transhumeral prosthesis than with a transradial?
rolling over
At what age range can a child use a body-powered hook?
2 - 3
At what age range can a child use a body-powered elbow?
4 - 5
What is the Vilkke procedure?
attaching a toe to the residual limb to create a pincer grasp
What is the most common lower limb deficiency?
fibular longitudinal deficiency (fibular hemimelia)
How often is fibular longitudinal deficiency bilateral?
25% of the time
What is the treatment of choice for a tibial deficiency?
knee disarticulation
What is PFFD
proximal focal femoral deficiency where the femur is short and held in flexion, abduction, and external rotation
What other deficiency is commonly associated with PFFD?
fibular deficiency (70 - 80% of the time)
What is the typical treatment for PFFD?
Fusion on the femur and tibia to allow acceptance of an above-knee prosthesis
When is a child with a lower-limb deficiency fit with a prosthesis?
When they are ready to pull to stand (9-10 months)
When does the normal child establish a heel-toe gait pattern?j
2 years old
When is a knee joint added to a child’s prosthetic lower limb?
18 months
What is the most common prosthetic foot given to children?
SACH
When is a polycentric knee a good choice?
long residual limb with difficult to match knee centers
About how often are prosthetic limbs replaced between 5 to 12 years old?
about every 2 years
What is the most common cause of pediatric acquired amputation?
trauma (MVC, train)
What is the most common cause of disease related amputation in children?
tumors (osteogenic and Ewing’s sarcoma)
Why is it important to retain the bony growth centers when performing a pediatric limb amputation?
To allow for continued growth and prevent distal bony overgrowth
What is the most common complication after amputation in a child?
terminal overgrowth
What is the most common site for terminal overgrowth after amputation?
humerus (terminal overgrowth is not funny)
What are predictors of ability to use power mobility in a child?
cognitive skills of spatial relationships and problem solving
What has been associated with increased likelihood of developing phantom pain after an acquired amputation in a child?
Older age, particularly over age 10
What are two maternal factors linked to congenital limb deficiencies?
cigarette smoking and poorly controlled diabetes
What are two advantages of the Van Nes rotationplasty?
proprioceptive control of the knee and ability to use reciprocating gait when climbing stairs
What type of amputation is preferred in pediatrics?
through joint
What can be done to prevent terminal overgrowth in a child if a through joint amputation is not possible?
stump capping
What is the most common long bone deficiency?
longitudinal fibular deficiency
What dictates surgical planning in fibular deficiency?
stability of the ankle and foot
How many rays are needed for ankle and foot stability in a fibular deficiency?
3 or more
When are foot ablation procedures preformed in a child with fibular deficiency who is a candidate?
when pulling to stand
What are the surgical options in a child with a fibular deficiency and unstable ankle?
Syme and Boyd amputations
What are the advantages of a Boyd amputation over a Syme?
heel pad stabilization, improved prosthetic suspension and weight bearing through distal end
What is the disadvantage of a Boyd compared to a Syme?
longer time until prosthetic fitting (6-8 weeks)
Deficiency of what bones warrant a genetic work-up?
radius and tibia
When can the knee be preserved in a patient with a tibial deficiency?
When there is active quadriceps function
What is the most common congenital limb deficiency that results in prosthetic or surgical complications?
PFFD
What dictates surgical treatment options in PFFD?
femoral length and stability of lower extremity joints
What are two treatments for phantom limb pain?
gabapentin and mirror therapy
