Weinstein Lovell and Winters Pediatric Orthopaedics 7e

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CHAPTER 30  |  The Child with a Limb Deficiency

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D FIGURE 30-54. A : The TRS ALPHA Infant Hand is an option for the first prosthetic hand offering age-appropriate fine motor activities. This would commonly be fitted between 4 and 6 months of age. The hand incorporates a flexible thumb that allows objects to be placed for simple grasp and release functions. B : The ADEPT is a voluntary closing body-powered hook that is fitted at approximately 15 months of age, if the child is ready and a body-powered device is desired. C : The Lite-Touch is a voluntary closing hand that would find the same indications as the ADEPT hook. It looks a bit more like a hand, which often makes this option popular with parents. D : The Variety Village hand is one of the most commonly used myoelectric hands in the pediatric age group. The Otto Bock Electrohand is shown in Figure 30-42. Both of these electric hands are covered with a cosmetic glove.

Endoskeletal versus Exoskeletal Construction.  The structure or construction of a prosthesis is referred to as an endo- skeletal (internal structure) or exoskeletal (external structure) prosthesis. Generally, transtibial, partial foot, and transradial prostheses are constructed exoskeletally, and transfemoral, knee disarticulation, hip disarticulation, transhumeral, and shoulder disarticulation levels of prostheses are constructed endoskeletally. Exoskeletally finished prostheses are more durable and better suited to the growing child. There are various ­techniques and materials used in the construction of the ­exoskeletal prosthesis. Generally, following the completion of dynamic alignment, the ready-to-be-finished prosthesis is placed within a transfer jig that allows the socket to be separated from the foot while maintaining alignment. A rigid polyurethane foam is added, and the prosthesis is cosmetically shaped to equal the sound limb. The structure is then laminated with acrylic resin forming the outer “shell.” The advantages of this con- struction are its increased durability and that it is easy to clean and structurally strong. The major disadvantages are the lack

prescribed. The canted design of the 12P hook allows for greater visual feedback to the wearer. In the event that a myoelectric device is warranted, the Variety Village 0-3 (VV 0-3) electric hand (Fig. 30-54D) or the Otto Bock Electrohand (Fig. 30-42) is used. In the pediatric VV 0-3 hand, the thumb and oppos- ing two fingers operate to form a three-point chuck grip. In the Otto Bock 2000 hand, the same principle is applied, except that from the open to closed position, the thumb sweeps from a lateral position to meet the two opposing fingers upon close. Progression from this starting point through the various component sizes and versions allows for a relatively smooth transition into adulthood. Prescription criteria are reviewed during each clinic visit, and changes are made on the basis of the child’s changing needs. In today’s environment of active children and sports activities, the use of sports or other adap- tive terminal devices is essential for the amputee. TRS has developed numerous devices for use in sports and recreational activities. These can be interchanged on the prosthesis, so that only one socket is required.