Weinstein Lovell and Winters Pediatric Orthopaedics 7e

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CHAPTER 30  |  The Child with a Limb Deficiency

Similarly, the weight-sensitive areas most affected include the tibial crest, fibular head, distal tibia and fibula, peroneal nerve, and the patella. The socket design is composed of an outer shell, inner soft liner, and a cosmetic cover. The patellar-tendon-bearing (PTB) socket is the stan- dard socket (Fig. 30-48A). It provides the least suspension,

and for that reason, is not often suitable for young children. The supracondylar/suprapatellar (SCSP) transtibial socket design (Fig. 30-48B) allows for suspension without the need for belts or cuffs. The medial, lateral, and anterior walls extend proximally, to fully enclose the patella and femoral condyles. The SC transtibial socket (Fig. 30-48C) is almost identical to

Quadriceps bar

A

B

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C

roiretnA E FIGURE 30-48.  Common sockets and suspensions for transtibial pediatric amputees. A : PTB socket is most useful for the mature patient. It gives the most freedom of motion, but the least secure suspension. B : The PTB-SCSP design gives the most secure suspension and best knee control of any of the sockets that incorporate the suspension in the socket. C : The PTB-SC socket eliminates the suprapatellar portion of the socket anteriorly, providing better range of motion but less control of hyperextension. D : The SC cuff suspension is a common suspension used in the pediatric age range. E : The neoprene sleeve suspension provides very secure suspension for the very active amputee. This can also be used for the transfemoral amputee. laideM D