3 of 3: Responses: Symes vs. Chopart
Monica Motloch
Description
Collection
Title:
3 of 3: Responses: Symes vs. Chopart
Creator:
Monica Motloch
Date:
7/24/2002
Text:
10). I have been working closely with a Pediatric Orthopedist for some time now and would recommend the possible Symes amputation with the following provisions, check the height of the patient against parents and siblings, is further surgery opposed by the parents, general size and activity levels
of the family. If good growth potential is possible, the Symes can be done and the growth plates can be sealed now, or at a later date, so that the patient ends up with a good BK length, along with distal end bearing, but the prosthetist still has room to adapt several components in the future as she grows to
adulthood. This procedure sometime requires several surgeries over many years to stop further growth, so it is important that the parents be well informed.
Timing is critical, but outcome can be excellent.
-Steve Dickerson, CP
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11). This is a hard one. I have manufactured both, and if done properly(surgery) both can give sound prosthetics functionally. However, the chopart amp creates big problems for cosmesis. As this is a female amputee I suggest you think about her teenage years, as at puberty this is when the cosmetic appearance will become all important for self perception. I have found that it is very very difficult to obtain a reasonable cosmesis with a Chopart amp.
Other side of the coin of course, is that a symes with a split liner is not
so great either.
A symes I feel is a better level, as when the patient grows, there will be
some shortening of the limb, and a better cosmesis can be achieved, as the
bone structure below the joint is removed.Please do not ask to have the
medio-lateral maleolii shaved. This loses suspension capability.
(trim distally) But im sure the surgeon will know this.
-Peter A Lewis CCPO Townsville Australia.
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12). With a chopart the calcaneous is intact which will preserve limb length, the problem with that is that this extra length limit's the prosthetist's
options with foot selection. With a properly performed symes amputation the calcaneous is removed and the keel pad is attached distally providing a good weight bearing surface and allowing more space for the foot.
Foot selection for a chopart is limited to the Springlite chopart carbon
foot plate. With a syme;s there is a large selection of feet available. We
have A LOT of symes amputees and very few problems with distal breakdown.
-Brian Pinkston C.P., L.P.
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13). As u have asked about the level of amputation and its usefulness
,in my opinion its better to go for a symes amputation or a B/K
amputation depends on the activities of the amputee. in symes
amputation there is a little bit problem in fitment of prosthetic
foot but as the client grows her activities will certainly
increses and that time u have more problem in foot replacement so
if u can then convince the parents to go for a good B/K amputation
and u can gave her more freedom of walking , running and
independence in her life . As u know there are so many type of
dynamic foot that u can fit to an ideal B/K prosthesis . Because
the amputee is child so the adaptation will be easy .
-Dewendra Prasad
---------------------------------------------------------------------------
14). I would suggest you contact some of the Shriner's hospitals around. I'm familiar with Scottish Rite in Dallas and get similar advice from them on occasion. You should be able to get the best info and experience through them.
I've worked with a few Chopart patients who had surgeries as children and are now in their 60's. Chopart seems to be preferable as it permits full
weight-bearing, presents a more stable distal end, maintains normal limb
length, and can be more cosmetic. The drawbacks are that an excellent
surgical technique is required to modify tendon insertions and give padding
to distal bone. Otherwise the sure result will be a plantar flexion
contracture and excessive distal pressure leading to breakdown.
Were it my child I would give serious thought to a BK level after consulting an orthopedist regarding the consequences for bone growth.
-Dave Gross CP
--------------------------------------------------------------------------
15). I do not know what the current amputation is like. However, once an amputation is done, there is no going back. At this age growth plates would be interrupted, causing a shortened limb as the child grows. From a functional stand point a symes or chopart is good but she is only 9 years old. While she is growing there will be routine replacement on her symes prosthesis; this is also true with a true chopart, but not as often. Unless the present amputation is very unusual you may want to stay with the chopart. You can always remove more. Again, I do not know all the specifics so this is all I can say. I have worked with a lot of children and almost all the time the children do well with most levels of lower limb amputations; therapy and home and clinical support is important. Sorry there is not a united front on this. Milwaukee children's hospital use to have an excellent amputee clinic. Dr. Al Kritter, Sr. and Dr. Bolt used to manage it. Dave Schultz, CPO was involved with the clinic itself for many years.
-Robert L Hrynko, CPO
---------------------------------------------------------------------------
Thank you for sharing this wealth of knowledge!!
Monica Motloch, CO, Prosthetic Resident
of the family. If good growth potential is possible, the Symes can be done and the growth plates can be sealed now, or at a later date, so that the patient ends up with a good BK length, along with distal end bearing, but the prosthetist still has room to adapt several components in the future as she grows to
adulthood. This procedure sometime requires several surgeries over many years to stop further growth, so it is important that the parents be well informed.
Timing is critical, but outcome can be excellent.
-Steve Dickerson, CP
------------------------------------------------------------------------------------------
11). This is a hard one. I have manufactured both, and if done properly(surgery) both can give sound prosthetics functionally. However, the chopart amp creates big problems for cosmesis. As this is a female amputee I suggest you think about her teenage years, as at puberty this is when the cosmetic appearance will become all important for self perception. I have found that it is very very difficult to obtain a reasonable cosmesis with a Chopart amp.
Other side of the coin of course, is that a symes with a split liner is not
so great either.
A symes I feel is a better level, as when the patient grows, there will be
some shortening of the limb, and a better cosmesis can be achieved, as the
bone structure below the joint is removed.Please do not ask to have the
medio-lateral maleolii shaved. This loses suspension capability.
(trim distally) But im sure the surgeon will know this.
-Peter A Lewis CCPO Townsville Australia.
--------------------------------------------------------------------------
12). With a chopart the calcaneous is intact which will preserve limb length, the problem with that is that this extra length limit's the prosthetist's
options with foot selection. With a properly performed symes amputation the calcaneous is removed and the keel pad is attached distally providing a good weight bearing surface and allowing more space for the foot.
Foot selection for a chopart is limited to the Springlite chopart carbon
foot plate. With a syme;s there is a large selection of feet available. We
have A LOT of symes amputees and very few problems with distal breakdown.
-Brian Pinkston C.P., L.P.
--------------------------------------------------------------------------
13). As u have asked about the level of amputation and its usefulness
,in my opinion its better to go for a symes amputation or a B/K
amputation depends on the activities of the amputee. in symes
amputation there is a little bit problem in fitment of prosthetic
foot but as the client grows her activities will certainly
increses and that time u have more problem in foot replacement so
if u can then convince the parents to go for a good B/K amputation
and u can gave her more freedom of walking , running and
independence in her life . As u know there are so many type of
dynamic foot that u can fit to an ideal B/K prosthesis . Because
the amputee is child so the adaptation will be easy .
-Dewendra Prasad
---------------------------------------------------------------------------
14). I would suggest you contact some of the Shriner's hospitals around. I'm familiar with Scottish Rite in Dallas and get similar advice from them on occasion. You should be able to get the best info and experience through them.
I've worked with a few Chopart patients who had surgeries as children and are now in their 60's. Chopart seems to be preferable as it permits full
weight-bearing, presents a more stable distal end, maintains normal limb
length, and can be more cosmetic. The drawbacks are that an excellent
surgical technique is required to modify tendon insertions and give padding
to distal bone. Otherwise the sure result will be a plantar flexion
contracture and excessive distal pressure leading to breakdown.
Were it my child I would give serious thought to a BK level after consulting an orthopedist regarding the consequences for bone growth.
-Dave Gross CP
--------------------------------------------------------------------------
15). I do not know what the current amputation is like. However, once an amputation is done, there is no going back. At this age growth plates would be interrupted, causing a shortened limb as the child grows. From a functional stand point a symes or chopart is good but she is only 9 years old. While she is growing there will be routine replacement on her symes prosthesis; this is also true with a true chopart, but not as often. Unless the present amputation is very unusual you may want to stay with the chopart. You can always remove more. Again, I do not know all the specifics so this is all I can say. I have worked with a lot of children and almost all the time the children do well with most levels of lower limb amputations; therapy and home and clinical support is important. Sorry there is not a united front on this. Milwaukee children's hospital use to have an excellent amputee clinic. Dr. Al Kritter, Sr. and Dr. Bolt used to manage it. Dave Schultz, CPO was involved with the clinic itself for many years.
-Robert L Hrynko, CPO
---------------------------------------------------------------------------
Thank you for sharing this wealth of knowledge!!
Monica Motloch, CO, Prosthetic Resident
Citation
Monica Motloch, “3 of 3: Responses: Symes vs. Chopart,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 1, 2024, https://library.drfop.org/items/show/219210.
