Prosthetic Management of a Child with PFFD

1
Prosthetic Management of a Child with PFFD

• Prepared by
• Elaine McCurrach
• BSc (Hons), MBAPO, SRPROS/ORTH
• Principal Prosthetist SMART, NHS Lothian

2
Presentation

• Aitken class C
• 2cm remnant of femur articulating in acetabulum
• femoral head is not present
• severe dysplasia of acetabulum
• Unstable hip             

3
Treatment Options

• Do nothing?
• Bone lengthening?
• Footwear adaptations?
• Prosthetic fitting

4
Prosthetic Requirements

• Restore leg length equality
• Lightweight
• Durable
• Stable
• Reasonably Cosmetic
• Review at least every 3 months

5
First Prosthesis - Socket Design

• Ischial Containment not tolerated
• High Trimlines for stability around hip
• Accommodate foot in plantarflexed position

6
First Prosthesis

• 9 months old pulling to stand
• 7cm shortening
• Pelite liner
• exoskeletal construction
• Childs SACH Foot
• Waist belt suspension

7
Component Choice

• Otto Bock Childs SACH Foot
• Small sizes
• dampens heel strike, child reaches a stable
  standing position quickly.
• Seattle Childs Play
• dynamic response Delrin keel.
• Improved Cosmesis
• Low build height

8
Problems with Prosthesis

• Wide walking base
• Lack of knee flexion - walking
• Lack of knee flexion - sitting

9
Amputation Surgery

• Symes Amputation 8 years old
• With epiphysiodesis
• Aim is to provide further 5cm shortening
• Functionally Transfemoral Prosthesis

10
Socket Design

• High Trimlines
• Ischial Containment
• True ICS not tolerated
• Both Ischial and End Bearing

11
Articulating Prosthesis

• Pelite liner
• Laminated socket
• Total Knee Junior
• Seattle Foot
• waist belt suspension
• physiotherapy

12
Paediatric Knee Geometric Locking system.
Weight limit 45kg Adjustable stance flex.
Adjustable extension promoterKnee flexes to 160
degrees.Weighs 0.38kg
Total Knee Junior
13
cosmesis
14
Gait Analysis

• Baseline measurement
• Allow video analysis of gait
• identified need for extension assist and
  physiotherapy

15

• REFERENCES
• Gait biomechanics and prosthetic management of
  children with proximal femoral focal deficiency
  (PFFD). FATONE S Capabilities
• Length of the PFFD stump after a Symes how long
  is enough? (abstract). WATTS HG Orthop Trans
• Energy expenditure and kinematic analysis in
  proximal femoral focal deficiency comparison of
  Syme amputation with Van Nes rotationplasty
  (abstract). Orthop Trans OPPENHEIM WL,
  SETOGUCHI Y, IRVINE D ... ET AL.
• Proximal femoral focal deficiency does a
  radiologic classification exist? SANPERA I,
  SPARKS LT J Pediatr OrthopEndoskeleta
  l Vs. ekoskeletal prostheses for the child with
  PFFD (abstract).AUTH SKEWES E.JRBK J Assoc
  Child Prosthet Orthot ClinSome concepts of
  Proximal Femoral Focal Deficiency. KING RE In
  Proximal Femoral Focal Deficiency a congenital
  anomaly a symposium, Washington,

16

• Thank you