AMPUTATION IN CHILDREN

The surgery for and management of

amputations in children is very different from
the adult. The majority of amputations in adults
are performed for complications of peripheral
vascular disease. The most common cause of
amputation in children is congenital limb
deficiency, followed by trauma, infections, and
neoplasms.
Difference b/w child and adult amputee

• There are a number of ways in which the

juvenile amputee differs from the adult. The
limb continues to grow. There is appositional
bone growth, especially of through-bone
amputations. The functional demands on the
residual limb and prosthesis are very different
for the playful, active child than those for the
more sedentary adult.
 Cont.
• The psychological factors of incorporating the
amputation and prosthesis into body image
are critical. The incidence of multiple limb
amputations is much more frequent in the
child, with their resulting complexity of
decision-making. Finally, the juvenile amputee
very rarely experiences phantom limb pain. 
 Principles of amputations
• Principles of amputations in children include
• 1) preserve all length possible
• 2) preserve growth plates
• 3) use disarticulations when possible
• 4) preserve the knee joint when possible
• 5) stablilize the proximal limb.
 Problems associated with congenital
amputations
• Child has never learned to function with that
extremity
• Early prosthesis of some type is needed so
child will use the arm
Etiology: Congenital

polydactyly
 Common problems
• Terminal overgrowth is the most common
complication of amputation surgery in the
skeletally immature individual. This is an
appositional overgrowth of new bone at the
transected end of a long bone
• Bone spurs often form at the periphery of
transected bone ends as a response to
periosteal stimulation at the time of surgery. 
• Neuroma formation in amputation stumps of
children is seldom symptomatic enough to warrant
surgical treatment.
• The phantom limb phenomenon always occurs in
children following acquired amputations. If the
amputation is performed on a child under the age of
10 years, the phantom sensation is rapidly
lost. Painful phantom limb sensation does not occur
in growing children, but has been reported in the
teenager.
• Anything of a prosthetic nature is an aid, not a
replacement, and if it is not truly an aid, the
child will reject it. Those who lose a limb due
to trauma or disease, unless their amputation
occurred when they were very young, will
have a profound sense of loss and undergo a
period of readjustment.
PROSTHESIS FOR RECREATION
Archery
Modern archery
equipment is reliable,
safe, and easily
adaptable to certain
terminal devices with
only minimal
modification. A bow
riser (handle) can be
layered with wraps of
rubber bicycle inner
tube and foam to
create a compressible
bow grip.
Ball sports
Prostheses should
provide adequate
strength, freedom
of movement, and
safety features.
Cosmetic hands
and externally
powered hands are
reported to have
been used
successfully.
Ball catching
BICYCLING/
TRICYCLING/
MOTORCYCLING
Upper-limb
requirements include
being able to grasp
and control
handlebars and
activate gears and
brakes. Safe control is
the primary goal. The
voluntary-opening
split hook has proved
less than ideal for
cycle control due to
the limited gripping
force and hook
contours.
BOWLING

.Bowling is primarily a
unilateral activity, so
people missing one
hand may not be
impaired or may wish
to switch hands to
bowl.
Bilateral amputees and
unilateral ones who do
not wish to switch
dominance need to use
a prosthesis.
DANCE/FLOOR
EXERCISES/TUMBLING

Passive cosmetic
hands have been used
as well as padded
hooks. Externally
powered hands are a
possibility for dance,
but the rigors of
gymnastics and
tumbling could
prohibit their
application
FISHING

Persons missing a
hand(s) or who have a
limb paralysis or
dysfunction have a
number of fishing
options. The
prosthesis must be
utilized to either grasp
a reel handle for line
retrieving or to hold
and control the fishing
pole
GOLF
Upper-limb prostheses
need to attach to the
club handle or grip in
some fashion. A
flexible or multiaxis
joint is required to
enable a complete
bilateral swing.
Persons missing one
hand have played golf
single-handedly, but
most amputees use
prostheses for
bilateral assist
GUNS/HUNTING

Rifles are easily

 

modified by adding
a ring or custom
adapter to the
forearm of the stock
. Custom handles
added to the
forearm of the stock
can also provide
excellent control
and stability.
MUSIC
Virtually all
adaptations for
playing musical
instruments are
custom-made.
Externally powered
hands as well as
body-powered
prehensors have all
been adapted from
time to time for
instrument play.