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Duke Orthopaedics
presents
Wheeless' Textbook of Orthopaedics

Growth Abnormalities in Amputation Stumps in Children

 


- See: Pediatric BKA:

- Overgrowth Phenomena:
    - occurs as a result of appositional growth (not physeal growth);
    - in order of frequency it occurs in the: humerus, fibula, tibia, and femur;

- AKA:
    - hemiatrophy of pelvis associated with coxa valga and elongation of lesser trochanter; femur and ilium usually smaller than on normal side;
    - overgrowth of bone in relation to the skin;

- Below Elbow Amputation:
    - pincerlike contour from overgrowth of radius in relation to ulna
    - tilting of proximal radial epiphysis may occur;
    - overgrowth of ulna with subcutaneous projection;

- Terminal BEA:
    - is the most common congenital amputation;
    - use of a passive device at 3-6 months for unilateral UE amputations (fit when they sit);

- Above Elbow Amputation:
    - humeral Varus;
    - overgrowth of humerus in relation to skin, causing subcutaneous projection;

- Children: Disarticulations:
    - deficient growth in residual limb (growth discrepancy) will convert anatomic disarticulation to the next highest level;
    - ankle disarticulation becomes functional AK, etc, if child is young;
    - for older child, consider epiphyseal arrest (eg distal femur), at just right time to give 1 or 2 inches of shortening;
    - what appears to be a very long above the knee amputation is a small child can result in a very short limb that is actually difficult to
           fit w/ a prosthesis at skeletal maturity;

- Misc: it is important to take out periosteum below the area of osteotomy



Operative treatment of bone overgrowth in children who have an acquired or congenital amputation.

Stump overgrowth in juvenile amputees.  

Function of Skin Grafts in Children Following Acquired Amputation of the Lower Extremity

Tibia Vara Deformity After Below Knee Amputation and Synostosis Formation in Children

Prevalence of Stump Overgrowth in Pediatric Burn Patient Amputations



Original Text by Clifford R. Wheeless, III, MD.

Last updated by Data Trace Staff on Friday, May 11, 2012 2:15 pm