Pediatric

Question 1

Special Considerations for Children (3)

Answer 1

• Growth (overgrowth) (exostosis)
• Activity level (almost always K4)
• ROM and Joint stability

Question 2

Fibular Hemimelia

Answer 2

• AKA Longitudinal Fibular Deficiency
• Congenital Absence of all or some of the fibula
• Unstable Ankle often results in an elective Through Ankle Amputation
• less involved cases might Not Require amputation => Limb lengthening and Shoe Lift
• typical limb; Anterior Bowing, Dimple, Equinovalgus
• Shortened femur on affected side, Valgus @ knee
• proximal joints might be affected; Increased ROM @ hip, Laxity @ Knee

Question 3

Normal Developmental Landmarks for Gait

Answer 3

6 months - sits without support

9 months - crawls freely, pulls to stand

12 months - walks with assistance

15 months- walks without assistance

18 months - creeps backwards downstairs

21 months - walks up and down stairs

24 months - runs

3 years - stands on one leg

4 years - hops on one foot

Question 4

Why Choose Disarticulation vs. Transection in a Child (5)

Answer 4

• Epiphyseal growth is preserved
• Terminal overgrowth is avoided
• Longer lever arm is maintained
• Suspension and rotational control is enhanced
• Residual limb is tolerant to Distal weight bearing

Question 5

Psycho-social Considerations for Children (6)

Answer 5

• Children are less responsible and more mentally and emotionally immature
• Removable components will get lost
• Instructions forgotten or ignored
• Fitting problems not reported
• Children are dependent on adults
• Parental education is extremely important
• Rapidly changing goals

Question 6

PFFD (Proximal Femoral Focal Deficiency)

Answer 6

• congential anomaly characterized by a failure of normal development of the proximal end of the femur and also femoral joint
• 50% of cases are associated with fibular hemimelia
• typically thigh is held in flexion, abuduction, external rotation
• foot is at level of opposite knee
• treatment; limb lengthening and shoe lift, prosthesis (with or without surgery), van nes rotation

Question 7

Van Ness Rotationplasty

Answer 7

• surgical treatment for PFFD or Osteosarcoma
• rotation of foot 180 degrees so that ankle row functions as a knee and is fit with a BK prosthesis
• must require ischial weight bearing
• problems include; cosmesis, risk of surgery, eventual rotation of ankle

Question 8

Socket Designs to Allow for Growth (6)

Answer 8

• socket liners, easy to modify and protection
• '’slip’’ or ‘‘triple well’’ sockets, ability to remove inner layer
• more socks - arm for a looser initial fit
• distal pads- longitudinal and terminal growth
• can be removal and pre poured
• flexible sockets - heated and stretched

(use modular components)

Question 9

Longitudinal Deficiency

Answer 9

• there is a reduction or absence of an element or elements within the long axis of the limb
• there may be normal skeletal elements distal to the affected bones
• ie: longitudinal deficiency of the R fibula, proximal third

Question 10

Transverse Deficiency

Answer 10

• limb has developed normally to a level byeond which no skeletal elements exist
• described by naming segment where the limb terminated then describing level within segment beyond which no skeletal elements exist
• ie: transverse deficiency of the right radius and ulna, proximal third

Question 11

Constriction Band Syndrome

Answer 11

• AKA Streeter’s Dysplasia
• may cause amputation, webbing of fingers or toes (syndactyly)
• caused by a defection in the amnion (sac around the baby during pregnancy)
• fetal parts became entrapped in fibrous bands in utero