Pediatric Limb Deficiencies Flashcards
What is terminal overgrowth
Spiking
Body powered prosthesis UE
As young as one, once kid can do it
K4 amputation level
The patient has the ability or potential for prosthetic ambulation that exceeds basic ambulation skills, exhibiting high impact, stress, or energy levels. (Child, active adult, or athlete.)
What is more common, upper or lower, pediatric amputations
Upper 3x Lower
Disarticulation or transdiaphyseal for kids
Disarticulation
Is phantom pain common in kids
No
Why disarticulation
Because it preserves ability for limb to grow
Which amputations, upper or lower, are most associated with other anomolies
Upper – esp related to craniofacial, cardiac, and hematologic (due to the chronology of 1st trimester)
Most common pediatric amputation problem
The most common complication in a skeletally immature child is bony overgrowth, or spiking. Bony overgrowth can occur in 40% of children5 and is usually in children with amputations acquired before the age of twelve.
K0 amputation level
The patient does not have the ability or potential to ambulate or transfer safely with or without assistance, and a prosthesis does not enhance quality of life or mobility
Where does amputation overgrowth most commonly occur
Overgrowth most commonly occurs in the humerus, followed by fibula, tibia, and femur.
How many kids with limb deficiencies will have other anomalies
8/10
K2 amputation level
The patient has the ability or potential for ambulation with the ability to traverse low-level environmental barriers, such as curbs, stairs, or uneven surfaces. (Limited community ambulator.)
Active terminal device
1 year, when can walk
Timing of lower prosthetic
Solid ankle cushion heel (SACH), infancy
K1 amputation level
The patient has the ability or potential to use a prosthesis for transfer or ambulation on level surfaces at fixed cadence. (Limited and unlimited household ambulator.)
When do you fit with prosthesis for lower limb
When ready to pull to stand, 9-10 months
What is common if amputations goes wrong
Terminal bony overgrowth
Knee joint
2-3
Timing of upper extremity prosthesis
Used to be six months, can sit and do bimanual. But now can be 3 to 6 months
Energy strong releasing feet
Toddler
Myoelectric
2
Rules of surgical management of amputations in kids
- Preserve length
- Preserve growth plates
- Perform disarticulation instead of transosseous
- Preserve knee joint
- Stabilize and normalize proximal portions
Which trimester is most important for embryogenesis of limb deficiencies
1st due to mesodermal formation of the limb at 26 days gestations until 8 weeks
Passive UE device
6 months classically when kid can sit
K3 amputation level
The patient has the ability or potential for ambulation with variable cadence. Community ambulator who has the ability to navigate most environmental barriers.
