Flashcards in Pediatrics Deck (47)
What is the peak age range for amputations?
41-70 years old (135K new cases each year in total)
What % of pediatric amputations are acquired?
40% are acquired (60% are congential)
Of the acquired amputations, how many are traumatic?
70% of acquired amputations (40% of total ampuations) are due to traumatic causes. The other 30% are a result of cancer
How many children are born missing some portion of their limb?
1/2000 children are born missing some portion of their limb
What are common causes of traumatic amputations in children?
DOORS, lawnmowers, BICYCLES (chains), power saws, and MVAs.
What diseases cause acquired amputations?
Ewing's Sarcoma (lung?)
What are some causes of congenital (embryonic) amputations? (2)
How do you manage an acquired, traumatic amputation? (7)
How do you manage an acquired amputation due to disease? (4)
Surgical removal of tumor
Limb sparing strategies
What are three goals for an acquired amputation due to disease? (3)
Control primary tumor
Control and disease
When do errors in limb development usually occur?
4-7 weeks of gestation
When must tetrogenic factors be present?
Some time between 3rd and 7th week
What is amniotic band syndrome?
Occurs when the fetus becomes entangled in fibrous string-like amniotic bands in the womb, restricting blood flow and affecting the baby’s development.
What are known tetrogenic factors for congenital limb deficiencies?
Thalidomide (morning sickness drug with side effect of fetal limb loss), contraceptives, irradiation.
What are four genetic factors linked with limb deficincy?
Holt-Oram, Franconi, Nager, and thrombocytopenia-absent radius symdromes
(can also be sporadic mutation)
How are acquired amputations classified?
Named for the segment which has been transected (transhumeral, knee disarticulation, etc.)
What are the three Greek-based classifications of congenital limb loss (which we will probably never use but we must be able to recognize)?
Amelia, Hemimelia, Phocomelia
What is Amelia?
Absence of a limb
What is hemimelia?
A shortened or absent limb due to long bone absence or insufficiency
What is phocomelia?
A congenital with a shortened or absent long bone and webbed hands and/or feet are attached to abbreviated arms and legs. This is often associated with, but not limited to, exposure to thalidomide. Also used when the top part of a limb is missing and distal part is attached to more proximal portion.
How are congenital limb losses classified today?
Based on amount of development and level
Approved by ISPO and ISO
What is the difference between a transverse and longitudinal deficiency?
Longitudinal - deficiency is up and down
Transverse - deficiency is L and R
What is the clinical presentation of PFFD (a specific birth defect)? (5)
Hip in FABER (frog leg)
Knee flexion contracture
Hypoplasia (underdevelopment) of quads
Small or absent patella
Instability of knee joint due to absence of the ACL and PCL
(overall, ligamentously unstable and stuck in flexion)
What is a non-surgical option to treat PFFD
"get a big shoe lift"
How is PFFD classified?
Position of the foot
Length of the femur and tibia
Condition of the hip joint
What is a type A PFFD?
Present femoral head
Short femoral segment
*Bony connections between components of femur; femoral head in acetebelum
What is a type B PFFD?
Present femoral head
Adequate or moderately dysplastic acetabulum
Short, usually proximal bony tuft femoral segment
*No osseus connections between head and shaft
Femoral head in acetabulum
What is a type C PFFD?
Absent femoral head (or represented by ossicle)
Severely dysplastic acetabulum
Short (usually proximally tapered) femoral segment
*May be connection between shaft and proxminal ossicle
*No articulation between femur and acetabulum
What is a type D PFFD?
Absent femoral head
Absent acetabulum, or obturator foramen enlarged; pelvis squared in bilateral cases
Short, deformed femoral segment