Weinstein Lovell and Winters Pediatric Orthopaedics 7e

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CHAPTER 30  |  The Child with a Limb Deficiency

A

B

FIGURE 30-44.  This child with congenital bilateral hip disarticulation and transhumeral amputations (A) was fit- ted with four prostheses (B) , which she quickly abandoned in favor of her power chair and simple assistive devices (C) .

C

Pearls and Pitfalls.  Children with bilateral amelia will depend on their lower extremities for all of their ADL. It is important to refrain from any lower extremity surgery until the full extent of lower extremity use is understood. It is especially important to avoid any lower extremity ampu- tation in these children if it interferes with their ADL.

Also, special ­considerations for treating spinal deformity in these patients are warranted. Because spinal flexibility may assist in allowing the lower extremities to substitute for the upper extremities, preservation of spinal motion is a spe- cial concern. If spinal fusion is necessary, limited fusion is­ indicated.