Introduction

The Pediatric Amputations section gives a comprehensive explanation of limb amputations as if a physician is sitting next to you taking the time to explain the medical details. Here you will learn more about amputations and prostheses. This knowledge will help maximize recovery, optimize health, prevent complications, and improve quality of life. Whether you are reading about your own amputation, a loved one’s, or trying to understand what others are experiencing you will benefit from this article.

What are the types of pediatric limb abnormalities?

In general there are two types of limb abnormalities seen in infants and children. Sixty percent of limb abnormalities occur before birth and are therefore referred to as congenital limb deficiencies. The other 40 percent result when a child is born with otherwise normal limbs but then sustains an amputation from trauma, tumor or infection.

What are the causes of congenital limb deficiency?

Parents should try to understand that when they have a child with a limb deficiency, there is often nothing that they did that resulted in this abnormality. In fact, according to the Association of Children’s Prosthetic and Orthotic Clinic (ACPOC), 60 percent of congenital limb deficiencies either have no known cause or are genetic in origin. Some congenital abnormalities may be due to poor blood supply, constricting amniotic bands. Only 4 percent are due to taking some type of drug or toxin (i.e., maternal drug exposure like thalidomide). Although many of these abnormalities cannot be prevented, some studies have suggested that taking a multivitamin with folic acid helps reduce the risk of congenital abnormalities, including limb deficiencies. Types of congenital limb deficiencies are shown in.

What are the types of congenital limb deficiency?

Some congenital limb deficiencies develop across the growing limb and are referred to as a transverse limb deficiency. For instance, the most common congenital limb abnormality outside of missing digits includes a deficiency across the forearm of the left  upper limb. This is also referred to as a transradial (across the radius) limb deficiency. Occasionally some congenital abnormalities are due to the complete absence or shortening of a leg or arm bone, but the rest of the limb beyond the absent or shortened bone developed normally. These types of abnormalities are referred to as longitudinal limb deficiencies. An example of this in the lower limb is Proximal Femoral Focal Deficiency (PFFD). This occurs because the infant’s thigh bone or femur did not develop normally. Other types of longitudinal deficiency occur where a child may be missing one of the two bones in the lower leg or arm. If a child has a complete absence of an entire limb or limbs, the condition is referred to as amelia. These patients appear and are treated similarly to children who have an amputation at the shoulder or hip. Phocomelia is another type of limb deficiency in which the mid-portion of a limb is missing and the hands or feet are attached directly to the trunk. The terminology used for congenital limb deficiencies can be quite complicated.

Do some congenital limb deficiencies have other medical problems associated with them?

There are some known congenital syndromes that also have other medical issues present in addition to the limb deficiencies. Some of these include the TAR Syndrome (low blood platelet counts), Holt-Oram Syndrome (heart defects), Fanconi Syndrome (anemia) and VACTERL Syndrome (spine, kidney and cardiac defects with throat, rectum and limb abnormalities). The care of these children necessitates treatment not only of the limb deficiency but also the associated medical problem. Some infants with congenital limb abnormalities may also have other musculoskeletal problems such as joint laxity or muscle weakness.

What are lower-limb deficiencies?

Children born with congenital lower-limb deficiencies or who sustain lower-limb amputations as a result of trauma or disease may have a combination of various limb abnormalities. For instance, some children may have a normal lower limb on one side with a complete absence of the lower limb on the other side. Complete absence of a limb is referred to as amelia if it occurred congenitally. However, if the child was born normally but then had the lower limb amputated at the hip, then the child would be said to have a hip disarticulation. There are many more combinations of limb abnormalities. For instance, other children may have a shortened thigh bone or femur due to a longitudinal deficiency and have a normally developed ankle and foot attached to this. However on the opposite side only the shin bone may be absent. Some children may have necessitated an above-knee amputation on one side and a below-knee amputation on the opposite side. Each of these situations certainly can be unique and represent challenges that the child, family and rehabilitation team may face. However, with the appropriate education, resources and teamwork, these individuals can lead normal fun-filled lives with the ability to do anything they set out to accomplish.

What are common causes of limb amputations in children?

The other type of childhood limb abnormality results when a child’s limb needs to be amputated due to trauma, infection, cancer or other disease. One leading cause of amputation in a child one to 4 years of age is from power tools such as lawn mowers or other equipment. In young teenagers, amputation due to tumors such as Ewing’s and osteogenic sarcoma are the most common. Males tend to get these tumors more commonly; they outnumber females three to two.Limb amputation in these cases can be especially difficult emotionally and physically, not only for the child but also for the parents. When discussing amputations with their doctor, it is important for the family and child to understand that many options exist. Considerations include ensuring that the underlying disease process is not only adequately treated but also leaves the child with the best functional limb possible. This may mean having a limb that fits a prosthesis well and functions optimally for the child. In contrast, some children may elect not to use a prosthesis at all, preferring to perform most tasks with their residual limb.If the situation permits, a family conference with the surgical and rehabilitation team allows parents and, when appropriate, the child to be informed regarding the rationale, technique and rehabilitation options that exist as a result of amputation. This gives family members the opportunity to ask many questions, many of which may deal with what the child will be able to accomplish following the surgery. Social work services as well as counseling are also made available during this time, which will help with the adjustment process once the amputation takes place.

What are the types of pediatric limb amputations?

 

What are some common terms used when discussing congenital limb deficiencies or amputations?

Residual limb:  term used for the amputated or congenitally abnormal limb; it is the preferred term rather than the older term “stump.”

Bilateral:  both sides of the body are involved.

Unilateral:  only one side is affected.

Neuropathy:  a condition where the nerves in the limbs become sick. This can lead to numbness, tingling, pain and weakness of the limbs.

Disarticulation:  a type of amputation that goes through a joint. Typically the end of the remaining bone remains intact and may serve as an excellent attachment for a socket. The type of disarticulation depends on which joint is involved (i.e., ankle or knee disarticulation).

Transradial amputation:  an amputation that goes through the bones of the forearm. This can either be short or long depending on how much of the residual limb remains.

Wrist disarticulation:  a type of upper-limb amputation where the hand is amputated through the bones of the wrist.

Elbow disarticulation:  a type of upper-limb amputation through the elbow joint.

Shoulder disarticulation:  a type of upper-limb amputation that goes through the shoulder joint.

Forequarter amputation:  a type of upper-limb amputation that involves removing not only the entire upper limb but also the shoulder blade. It is usually performed to treat cancers.

Below-knee amputation:  any amputation that involves the structures below the level of the knee. Types of these include transtibial (across the tibia or shin bone), Syme’s or partial-foot amputations.

Transtibial amputation:  amputation of the lower limb that goes across the shin bone or tibia. This amputation may either be short or long depending on the length of the residual limb.

Syme’s amputation:  a type of amputation just at or right above the ankle joint.

Chopart amputation:  a partial foot amputation located just past the ankle joint.

Lisfranc amputation:  a partial foot amputation located through the middle of the foot.

Above-knee amputation:  any amputation that involves structures above the knee, typically across the thigh bone or femur (transfemoral).

Transfemoral amputation:  a type of lower-limb amputation that occurs through the thigh bone or femur. These amputations can either be short or long depending on the length of the residual limb.

Hip disarticulation:  an amputation that removes the entire lower limb from the hip joint.

Hemipelvectomy:  an amputation of the lower limb that extends through part of the pelvis.

Hemicorpectomy:  an amputation of the lower limb that also removes the entire pelvis.

Additional important terms an amputee should know:

Donning:  the act of putting a prosthesis on.

Doffing:  the act of taking a prosthesis off.

Prosthesis:  any device that serves as an artificial substitute or replacement of a part of the body. Sometimes this is referred to as an artificial limb and may be used for appearance and/or function.

Componentry:  parts that make up the prosthesis.

Prosthetist:  someone who makes a prosthesis.

Socket:  the part of the prosthesis that holds it onto the residual limb. There are various types of sockets depending on the type and shape of the residual limb.

Supracondylar Cuff:  a type of socket and suspension used when a limb deficiency occurs below the knee. It typically involves a socket that extends over the bony prominences at the end of the thigh bone, which are called condyles (hence supracondylar). Occasionally, this is referred to as a patellar tendon-bearing brace because the person’s weight is borne on the tendon running from the kneecap (patella) to the shin bone.

Liners:  usually a synthetic material placed over the residual limb that will help to improve contact between the residual limb and the prosthesis. These are also used to keep the limb in the prosthesis when using a suction suspension.

Ischial containment socket:  a type of socket used in above-knee amputations or congenital deficiencies. The ischium, a bone of the pelvis, is often held within the socket together with the residual limb. The ischium is the part of the pelvis that we sit on and is good for weight bearing

Quadrilateral socket:  a type of socket used in above-knee amputations or congenital deficiencies. It is named because it typically has four walls (hence quad).

SACH foot:  acronym for Solid Ankle Cushioned Heel or SACH. This is a basic type of foot used in many lower-limb prostheses. Usually it is used in people who are less active.

Suspension system:  the way in which the prosthesis is held onto the residual limb. This may involve a belt or suction to hold the prosthesis on the limb

Exoskeleton:  usually a type of prosthesis made of wood or plastic, shaped to look like the other normal limb.

Endoskeleton:  usually a prosthesis made of a rigid metal or plastic. Typically, there is a long tube or pylon that makes up most of the prosthesis. This pylon can be covered with synthetic material so that it looks more natural.

Terminal device:  refers to the end of an upper-limb prosthesis that is used to carry out functional activities. It is easier to think of the terminal device as the working “hand” of the upper-limb prosthesis.

Control system:  refers to how an upper-limb prosthesis is powered or moved. The two most common forms are either body powered or myoelectric.

Body-powered prosthesis:  with a body-powered prosthesis in the upper limb, movement of the terminal device, elbow or shoulder occurs by moving some other part of the body. For instance, when the individual’s shoulder and shoulder blades are moved they pull cables that control the terminal device (hand) and/or elbow.

Myoelectric prosthesis:  a prosthesis that has sensors inside the socket that detect muscle activity created by the child’s voluntary movement. The sensors detect this electrical activity and then amplify the signal, which in turn causes the terminal device to open or close.

Voluntary opening device:  a type of terminal device or “hand” in an upper-limb prosthesis where the terminal device is held forcibly in a closed position. It is then opened either by manually opening the device by the opposite hand or by using body power or electricity (i.e., myoelectric).

Neuropathy:  sickness of the nerves of the limbs. Although this condition may be painful, it also often results in decreased sensation, leaving a limb at risk for infection due to minor trauma.

Rotationplasty:  a surgery where the affected part of the limb is removed, but the remaining limb is then rotated and reattached. This procedure is sometimes used in orthopedic cancer surgery to spare some of the limb, often using the ankle joint as a knee joint and is referred to as a VanNess Rotationplasty. This procedure is usually used in children with congenital leg problems.

Transfers:  term used to describe moving from lying to sitting and sitting to standing positions.

Activities of Daily Living:  often referred to as ADLs. These activities consist of bathing, dressing, toileting and dressing oneself. It also involves mobility issues such as getting in and out of a tub or out of bed. Usually occupational therapists help show people how to do ADLs

Physical therapist:  an individual within the rehabilitation team who uses exercises and other treatments to help individuals with disabilities regain mobility and function, such as walking.

Occupational therapist:  an individual within the rehabilitation team who uses exercises and modalities to help individuals perform activities of daily living (ADLs) such as bathing, dressing, toileting and transferring.