Indications
1. Congenital Limb Deformity
- 60%
- rare for UL
- PFFD / Tibial Hemimelia
2. Tumours
3. Trauma
- 26%
Considerations
Growth
Diaphyseal amputation removes one of physes
- progessive LLD
Aims
1. Preserve physis via disarticulation
2. Preserve as much bone length as possible
Overgrowth
Terminal overgrowth of stump
- occurs when appositional growth of bone exceeds that of surrounding soft tissues
- may result in penetration of bone through skin
- occurs in 10%
- most common in humerus, fibula, tibia & femur
Treatment
1. Stump revision with adequate resection of bone + myoplasty
2. Autogenous osteochondral stump capping
Phantom Limb sensation
Always occurs in children
- < 10 years old settles rapidly
- not painful usually
Prosthetics
Should coincide with normal motor skill development
Upper limb
Age 4-6 months
- when sitting balance required
- passive terminal device
Age 2-3 years
- add active cable control with voluntary terminal opening device
- when starts object manipulating with terminal device
Lower Limb
Age 8-12 months
- terminal device
- for AKA, add knee device when child walking well
Age 5-6 years
- more elaborate devices
- gait retraining