Limb Deficiencies And Amp Flashcards
When do limb buds first appear?
End of 4th week of embryonic development
When is there a recognizable skeleton?
End of the 7th week
Causative factors for improper limb development
Must be present at some time between 3rd and 7th week of development
Thalidomide
Contraceptives
Irradiation
Limb deficiency classification
Failure of formation of parts (arrested development)
Failure of differentiation (separation of the parts)
Duplication
Overgrowth
Undergrowth
Congenital constriction band syndrome
Generalized skeletal deformities
Transverse limb development
Normally until a certain level beyond which no skeletal elements exist
Most are unilateral
Most common transverse UE deficiency below elbow
Longitudinal limb growth
Reduction or absence of a limb element w/in long axis of lumb
Most common LE deficiency
Abscence or hypoplasia of proximal femur with varying degrees of involvement of the acetabulum, femoral, head, patella, tibia fibula
May be unilateral or bilateral
Clinical pattern of short leg held in flexion, abduction and ER
70-80% have total longitudinal deficiency of the fibula
Acquired amputations 70-80% attributed to
Trauma
Leading causes of acquired amputations
Machinery Household power tools MVA GSW Railroad accidents
Rest due to disease: tumor, infection, vascular abnormalities
Disease related amputations
Primary bone tumors rare in children
Osteosarcoma: primary malignant tumor of bone
Cause unknown but can be linked to ionsizing radiation
Peak incidence is w/ pubertal growth spurt
Common site for osteosarcoma
Distal femur
Proximal tibia
Humerus
Ewing’s sarcoma
Malignant primary tumor
Involve both the bone and soft tissue at time of dx
Pelvis, femur, tibia, ribs, humerus
Amputation: preserve
Physes if possible to allow for growth
60% of predicated femoral length needed for
Lengthening procedure to be viable
Sx option for PFFD if lengthening not an option
Knee arthodesis and foot amputation
Rotationplasty
Option for congenital PFFD or bony tumor in proximal tib/distal femur
Excision of distal femur and proximal tibia w/ 180 deg rotation of residual lower limb, reattachment
Backwards ankle works as knee
Rotationplasty adv
Improves limb length, good prosthetic function, good WB ability, avoiding overgrowth/ phantom limb pain
Rotationplasty disad
Poor cosmetics and deterioration of foot
Rotationplasty ROM requirements
0-20 deg DF
45-50 deg PF
Contras to resection of tumor
Tumor that has extensively invaded surrounding soft tissue, involves neurovascular supply or is the intramedullary cavity
Precautions to resection of tumor in bone
Skeletal immature kids due to extensive LLD caused
Limb replantation
Re-attachment of amputated limb
-distal replantation of UE is usually more successful than proximal
Body powered suspension systems and terminal device
Figure eight harness and chest strap
-fit over involved limb shoulder and around chest to suspend prosthesis or control terminal device
Externally powered UE prosthetic
Myoelectric devices
Foot: SACH foot
has been mainstay for peds
Flexible plastic
Dynamic response or energy storing feet
Shank LE
Exoskeletal rigid foam w/ laminated outer covering
Endo - pylon of ultralight graphite/titanium which is covered w/ foam
Single axis poly centric
Knee- functions at a set walking speed
Polycentric knee
Mimics an anatomic knee joint to increase stability. Axis is post in stance and ant in swing
Hydraulic and pneumatic knee
Variable friction allows for variable walking and running speed
Suspension prosthetics
Young children - supracondylar socket
Infants/toddlers - Silesian belt or total elastic suspension
PT intervention w/ prosthetics overall goal
Facilitate as normal sequence of development as possible
UE typically fitted (infancy)
Between 5-7 mo for early play in sitting and WB prone
LE prosthetic for infancy and toddlerhood
Under 2 - prosthesis w/out knee
Prosthetic knee added around 3 y after better control of amb
Children w/ prosthetic by school age
UE - activate thermal device by this age
LE- functional amb,
Prosthetics and teen driving
Nearly all teens can learn to drive no matter the level of amp.
Hand controls
