Prosthetics in Pediatric Orthopedics

Prosthetics in Pediatric OrthopedicsProstheses are artificial substitutes for body parts. Most prostheses for children are designed to replace limb deficiencies secondary to congenital, traumatic, or neoplastic problems.

Naming Prostheses

Name the prosthesis based on the level of the deficiency or type of amputation.

Prescribing Prostheses

Detail each element of the limb.

Special Needs of Children

Children have special prosthetic needs. Children grow, making prosthetic adjustments necessary 3–4 times a year. The prosthesis must be rugged and simple in design. Because multiple limb deficiencies occur in up to 30% of congenital losses and 15% of acquired losses, customized prosthetic management is often necessary.

Age for Fitting

Lower limb Fit lower limb prosthetics when the child first pulls up to stand, about 10 months of age. Initially, the knee may be omitted to keep the limb simple, light, and stable. Delay bilateral amputee fitting a few months.

Upper limb The timing of fitting upper limb deficiencies is controversial. Some fit at about 6 months of age. Others prefer to wait until a need is recognized by the child, which usually occurs in mid-childhood.

Acceptance

Lower limb prostheses are well accepted as they clearly enhance function and appearance. Stability and symmetry required for walking are readily provided by the prosthesis.

Upper limb prostheses are less well accepted. Some find the artificial limb to be a burden without sufficient compensation in improved function to justify the trouble. The lack of sensibility limits function. Children learn to function well with one hand. Children seldom use the prehensile function of upper limb terminal devices. Cosmetic hands are useful in adolescence.

Myoelectric Power

Powered limbs have the advantage of slightly improving appearance but the disadvantages of being more complex, heavier, and slower. The results are mixed.

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