Introduction: Amputation is one of the oldest surgeries known to the human race. The principles of amputation in children are different than in adults. Common indications for amputation include congenital, traumatic, infection, malignancy, vascular, and other pathology. Improper prosthetic fitting or inability to use the most modern available prosthesis can lead to dissatisfaction and compromised high-level function. The aim of this study was to assess residual limbs for compatibility to fit the most modern prosthetic components.
Methods: This study is a retrospective review of medical records of patients who underwent amputation between the pelvis and midfoot before 18 years of age. Age, sex, etiology, and level of amputation were recorded. A senior certified prosthetist graded the limbs based on limitations the residual limb imposed on options for the highest functioning modern prosthetic components.
Results: Sixty-one patients were identified (35 male, 26 female) with a mean age at assessment of 17.35 years (range, 1.86– 35.35 years). Congenital causes and tumors were the most common etiology. Amputations around the ankle were most common (25), followed by transtibial (20). There were 59% grade 1 limbs with no restrictions to component options, 28% grade 2 with moderate restrictions, and 13% grade 3 or severely limited component options due to the residual limb. Most grade 1 residual limbs were transtibial or proximal. Amputations distal to transtibial were of all grades.
Conclusions: The choices for optimal high-level prosthetic components are much less limited for transtibial amputation than more distal amputations leading to potentially less high-level prosthetic function. Managing the residual limb length and prosthetic fitting ability is an important element in pediatric amputations if the goal is to fit mature young adults with the highest functioning level prosthetic components. (J Prosthet Orthot. 2022;34:10-13)
The Centers for Disease Control and Prevention estimate that each year 2250 babies are born with congenital limb deficiencies, and more than 110,000 children younger than 18 years presented to emergency rooms with traumatic amputation during a 12-year period.
The principles of amputation in children are different than in adults due to children's specific requirements and growth potential. Amputation surgeries per se are uncommon in the pediatric population, but the common indications are congenital, traumatic, infections, malignancies, vascular, and other pathology. The considerations of the level of amputation aim to have an adequate residual limb, which can properly power a prosthesis, allow weight bearing, and accommodate the most functional prosthesis.
Innovative prosthetic components, materials, and technologic advances continue to expand the options available to pediatric patients with amputations. Prosthetic engineering has not only changed the way we rehabilitate patients with amputations but has also raised the level of activity that these patients can perform. The principles required to create a residual limb capable of accepting the best function-restoring prosthesis must be considered in both planning the amputation level and managing the growing child. With the available modern prostheses, children and young adults can participate in many of the high-demand sports activities. Most pediatric-age persons with amputation do not have the frequent physiologic limitations of cardiovascular disease that limits many older individuals with amputation who have had amputations for vascular disease or have other comorbidities.
These pediatric-age persons with amputation who become young adults are one group who can maximize their function, likely similar to young adults with amputation, using the most modern prosthetic components that are available. To be able to fit these modern prostheses, the residual limb must be adequate, with residual limb length an important consideration. The aim of our study is to evaluate if the residual limb of pediatric amputations presenting at our center at maturity have a residual limb capable of fitting the most modern available prosthetic components.