Limb Deficiencies And Amputations Flashcards
Etiology of congenital limb deficiencies
Congenital 60%
Acquired 40%
Limb buds first appear at the end of the 4th week of embryonic development
- UE precede the LE
- by the end of the 7th week there is a recognizable skeleton
Causative factors
- must be present at some time between the 3rd and 7th week of development
- exact cause is unkown usually the result of genetic mutation
- may be caused by involvement of the subclavian artery disrupting blood flow to the UE during early development
- several teratogenic causes. Thalidomide, contraceptives, irradiation
Classification
Failure of formation ofhe parts
- failure of differentiation
- duplication
- overgrowth
- undergrowth
- congenital constriction band syndrom
- generalized skeletal deformities
Transverse classification of limb development
Limb develops normally until a certain level beyond which no skeletal elements exist
-most are unilateral
-most common UE deficiency below elbow
Longitudinal classification of limb development
Reduction or absence of a limb element within the long axis of the limb
-normal skeletal elements may exist past the affected area
Proximal femoral focal deficiency
- most common LE deficiency
- absence of teh proximal femur with varying deg of involvement pf the actabulum, femoral head , patella, tibia and fibula
- deficiency may be unilateral or bilateral
- mild cases may require limb lengthening procedures, while more advance cases may require amputation and prosthetics
- clinical pattern of short leg held in flexion, abd, ER
- severe leg length discrepancy
- 70-80% have total longitudinal deficiency of the fibula
Osteosarcoma
Primary malignant tumor of the bone
- cause unknown but can be linked to ionizing radiation
- peak incidence is with pubertal growth spurt
- most common site: distal femur, proximal tibia, and humerus
Ewing’s sarcoma
- malignant primary tumor
- involve both the bone and soft tissue at the time of diagnosis
- primary sites are pelvis,femur,tibia, ribs, humerus
Rotation plasty
- option for congenital PFFD or bony tumors in proximal tibial/distal femur
- involves excision of te(distal femur and proximal tibia with 180 deg rotation of ten residual limb,
- backward ankle works as knee
ROM requirements 0-20 DF 45-50 PF
Advantages of rotationplasty
Improved limb length, good prosthetic function,good WB ability, and avoiding overgrowth/phantom limb pain
Disadvantage to rotationplasty
Poor cosmesis and deterioration of foot
Limb sparing procedures
-resection of tumor in bone and reconstruction of limb tonpreserve function w/o amputation
Excised area may or may not be replaced with endoprosthetic implant
Contraindications for limb sparing procedures
Tumor that has extensively invaded surrounding soft tissue, involves neurovascular supply or is in the intramedullary cavity
Precaution for limb sparing procedure
-skeletally immature kids due to extensive LLD caused
Limb replantation
- re-attachement of the amputated limb
- distal replantation of the UE is usually more successful than proximal
