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Amputations & Prosthetics > Pediatrics > Flashcards

Pediatrics Flashcards

1
Q

pediatric vs. adult amputations

A
  • Children’s MS system continues to develop with growth

- Children are emotionally immature and dependent upon adults for care and decisions

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2
Q

causes of pediatric amputations

A
  • Acquired (40%)
  • Congenital (60%); Not as common anymore due to less use of teratogenic drugs; Limb buds are formed during first trimester (before 12 weeks)
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3
Q

congenital limb deficiencies

A

transverse and longitudinal

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4
Q

transverse congenital limb deficiency

A
  • Normal development to a certain level with no skeletal elements existing below; with exception of digital buds
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5
Q

naming transverse congenital limb deficiency

A
  • Named by the segment in which the limb terminates and then described at the level within the segment
  • Example - upper arm middle third
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6
Q

longitudinal congenital limb deficiency

A
  • Reduction or absence of parts of the long axis of the bone
  • Normal bony parts may exist distal to the affected long axis
  • Example - missing fibula, but foot is intact OR ulna and 4-5th fingers gone, but hand including thumb and 1-2nd fingers intact
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7
Q

naming longitudinal congenital limb deficiency

A
  • Named by naming the bones affected in a proximal to distal sequence stating whether totally or partially absent
  • Example - ulna middle third, carpals partial, phalange 1 total
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8
Q

acquired amputations

A

traumatic and disease-related

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9
Q

causes of traumatic amputations

A

Farm machinery, power tools, MVA, GSW, explosions, railroad accidents

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10
Q

disease-related amputations

A

sarcoma of the bone - osteosarcoma and ewing’s sarcoma

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11
Q

sarcoma of the bone red flags

A

pain not explained by MS problem, pain without recall of an injury, constant type, bone pain (deep type)

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12
Q

complications in pediatric amputations

A
  • Osseous overgrowth (exostosis)
  • Overgrowth of fibula
  • Note: incidence common for both among children under 10 and traumatic amputations
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13
Q

surgical considerations

A
  • Preservation of all possible epiphyses (longer residual limb)
  • Disarticulation whenever possible
  • Wound healing is rarely a concern
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14
Q

benefits of disarticulation amputations

A
  • Preserves physes if possible
  • Epiphyseal growth is preserved
  • Terminal overgrowth is avoided
  • Longer lever arm
  • Suspension and rotational control are enhanced
  • Residual limb tolerant to distal WB
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15
Q

limb lengthening

A
  • Usually involves several surgeries
  • Long recovery period
  • Number of risk
  • Can add up to 6 inches of length
  • Ilizarov - most common procedure
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16
Q

limb replantation

A
  • Goal - restore pain free function better than could be obtained with a prosthesis
  • Rarely see phantom limb pain
17
Q

phantom limb sensation in pediatrics

A

increases with age of child; typically not painful, but ability to more amputated limb

18
Q

use and type of prosthesis dependent upon

A
  • Family choice

- Child’s maturational level (physical and mental)

19
Q

treatment considerations

A
  • Standard prosthetics vs Non-standard prosthetics
  • Growth - longitudinally and circumferentially
  • Endo (pylo) vs exo-skeleton (cosmesis)
20
Q

why use non-standard prosthesis

A
  • When parents refuse or delay surgical conversion
  • When it is necessary to sue the feet or hands for ADLs
  • Prosthetics are as varied as residual limbs
21
Q

how to accommodate growth longitudinally and circumferentially

A
  • Start with added socks and distal pads
  • Frequent follow-up
  • Need to be reinforced for active childhood development and sports
22
Q

UE prosthesis components

A
  • Body powered or externally powered (myoelectric) or a combination
  • Terminal device - “foot of the UE” = Passive hand, Hook (voluntary or closing), Myoelectric
  • Suspension - harness or suction (typically only for young children)
23
Q

LE prosthesis components

A
  • Socket
  • Suspension
  • Knee (TF)
  • Foot: SACH more common than energy-storing
24
Q

when is the LE knee component introduced and why?

A
  • not usually used in child until 2+ years (static knee instead)
  • Can begin to control dynamic knee around 3 years
25
Q

psycho-social considerations

A
  • Adult responsibility put upon a child
  • Child’s acceptance often depends on family acceptance
  • Vocation can still be chosen
26
Q

PT-specific considerations

A
  • Positioning and ROM
  • Development
  • Should be appropriate for developmental age
  • Early prosthesis = improved motor development?
  • Pre-school and early elementary
  • School age and adolescent
27
Q

age dependent fitting for UE and LE

A
  • UE usually fit @ 3-6 months
    Starting with functional terminal device and cable device with bimanual play begins
  • LE usually fit @ 8-10 months (when they begin pull to stand); AD used initally
28
Q

pre-school and early elementary age PT

A
  • Adapt environment in school
  • Add elbow @ 3-4 years
  • Can functionally use knee @ 3 years - start with constant friction
  • Use walker b/c crutches are too difficult at 1-3 years
  • PT monitor prosthetic fit, ROM, and strength
  • Emphasize development of independence in self-care skills, mobility (including running), and pre-K skills
  • Always allow feet and/or mouth for play and self-cares
29
Q

school age and adolescent age PT

A
  • Work on jumping, running, skipping, game skills
  • May prefer not to use prosthesis
  • Sports activities
  • Driving

Amputations & Prosthetics (6 decks)

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