Reply summary: pediatric knee orthosis
Ted Trower
Description
Collection
Title:
Reply summary: pediatric knee orthosis
Creator:
Ted Trower
Date:
2/7/2003
Text:
My original question was:
I have a four year old Trans-Tibial amputee who is showing a lot of knee
joint instability, especially in hyperextension. I may just have to fit
him with side joints and thigh lacer but I want to review my other option
of using a knee orthosis. What companies exist that produce a KO of
suitable size or an elbow orthosis that can be adapted?
Responses Follow:
==========================================================
I've had a young patient with the same problem and it was controllable with
a SC/SP socket. Have you tried that yet? It would keep the bulk down if
that is an option.
-------------------------------------------------------------------------------------------------------------------
Why not an SCSP? Is the child fibular deficiency?
Let me know...brings me back to my Shriner's days!
-------------------------------------------------------------------------------------------------------------------
Is it possible to try a suprapatella/supracondylar brim? i fit
them all the time anyway, but in particular i had a kiddo with cornelia
delang who had a very rounded posterior and would just rotate the socket
off. when i fit him with a good suprapatella that held him in flexion it
worked well. need a UW high posterior with hamstrings trim.they can still
overcome the suprapatella for balance, but have to work really hard to do
it in gait if the foot heel function is okay. kind of like flex foot if
you can manipulate the heel and toe. short heel lever, soft enough toe
for terminal stance rollover
hamstrings/quads/hips okay? seems weird to have such hyperextension.
why transtibial? trauma? congenital? is the laxity cruciate pathology?
-------------------------------------------------------------------------------------------------------------------
>Ted Trower wrote:
>
> > He's traumatic, lawnmower. Don't really know if the ACL is intact or not
> > but he has about 15-20 degree hyperextension range.
>
>hmmm. well, if you haven't given up on my SC/SP suggestion, the fib def
>kids have lax cruciates and funky hamstrings. they don't seem to sublux
>when i keep them in 5 and up to 10 degrees of flexion with the SP
>modification. at 4 he doesn't have much leg length to mess with. i think
>when you put joints in you get too far away from being able to put the 3-pt
>pressure system ( or in this case 4pts) in near the joint centers.
>
>on your current side joint set up, can you put the equivalent of a
>suprapatella pad (orthotics stuff again) so you can limit his knee flexion
>in combination with your socket? if he subluxes that won't help.
>
>the craziest thing to do is to unweight his knee by making him ischial wt
>bearing and then you can limit his knee ext ROM with joints until he gets
>back to normal if it is pathological.
>
>i am so spoiled by having the hospital docs with med recs and exams that
>would help figure out what's cooking with his knee. it bothers me to not
>know what is going on. we had a kid who fractured her distal femur and had
>a hyperextended knee and a bunch of weired alignment. she was already older
>when i was there though.
>
>oh and to give you an answer to your original question: bock has some
>pediatric O joints that come with no ROM and you sand the joints to get the
>ROM you want. since they are O joints, you wind up replacing the knee
>bearing nut, but they are pretty tough. used to make lots of PFFD side
>joints with them at gillette. SS joints, but they are small enough.
>
>i think they are the 17K32. since they are SS you can lateral bend them to
>be flexed if you need to, or just fab them to the socket (running from the
>knee center toward the anterior distal end of the socket ) so they stop when
>the knee is still flexed. if you do this, you can probably don't need
>limited ROM, really only flexion is limited. you can get the uprights
>contoured very close to your axis and i think we even turned them upside
>down so we could fab them easily into our sockets. haven't used them in a
>while, just once since i have been here.
-------------------------------------------------------------------------------------------------------------------
>Have you tried an SCSP socket? I would give it a whirl. You might be
>surprised and if it does not work, you can always cut it down and add the J
>& C.
==========================================================
My sincere thanks to all who replied. Not many options in the area of a KO
but hadn't really given much thought to an SCSP design. Will look into that.
Ted A. Trower C.P.O.
A-S-C Orthotics & Prosthetics
Jackson, Michigan, USA
www.amputee.com
I have a four year old Trans-Tibial amputee who is showing a lot of knee
joint instability, especially in hyperextension. I may just have to fit
him with side joints and thigh lacer but I want to review my other option
of using a knee orthosis. What companies exist that produce a KO of
suitable size or an elbow orthosis that can be adapted?
Responses Follow:
==========================================================
I've had a young patient with the same problem and it was controllable with
a SC/SP socket. Have you tried that yet? It would keep the bulk down if
that is an option.
-------------------------------------------------------------------------------------------------------------------
Why not an SCSP? Is the child fibular deficiency?
Let me know...brings me back to my Shriner's days!
-------------------------------------------------------------------------------------------------------------------
Is it possible to try a suprapatella/supracondylar brim? i fit
them all the time anyway, but in particular i had a kiddo with cornelia
delang who had a very rounded posterior and would just rotate the socket
off. when i fit him with a good suprapatella that held him in flexion it
worked well. need a UW high posterior with hamstrings trim.they can still
overcome the suprapatella for balance, but have to work really hard to do
it in gait if the foot heel function is okay. kind of like flex foot if
you can manipulate the heel and toe. short heel lever, soft enough toe
for terminal stance rollover
hamstrings/quads/hips okay? seems weird to have such hyperextension.
why transtibial? trauma? congenital? is the laxity cruciate pathology?
-------------------------------------------------------------------------------------------------------------------
>Ted Trower wrote:
>
> > He's traumatic, lawnmower. Don't really know if the ACL is intact or not
> > but he has about 15-20 degree hyperextension range.
>
>hmmm. well, if you haven't given up on my SC/SP suggestion, the fib def
>kids have lax cruciates and funky hamstrings. they don't seem to sublux
>when i keep them in 5 and up to 10 degrees of flexion with the SP
>modification. at 4 he doesn't have much leg length to mess with. i think
>when you put joints in you get too far away from being able to put the 3-pt
>pressure system ( or in this case 4pts) in near the joint centers.
>
>on your current side joint set up, can you put the equivalent of a
>suprapatella pad (orthotics stuff again) so you can limit his knee flexion
>in combination with your socket? if he subluxes that won't help.
>
>the craziest thing to do is to unweight his knee by making him ischial wt
>bearing and then you can limit his knee ext ROM with joints until he gets
>back to normal if it is pathological.
>
>i am so spoiled by having the hospital docs with med recs and exams that
>would help figure out what's cooking with his knee. it bothers me to not
>know what is going on. we had a kid who fractured her distal femur and had
>a hyperextended knee and a bunch of weired alignment. she was already older
>when i was there though.
>
>oh and to give you an answer to your original question: bock has some
>pediatric O joints that come with no ROM and you sand the joints to get the
>ROM you want. since they are O joints, you wind up replacing the knee
>bearing nut, but they are pretty tough. used to make lots of PFFD side
>joints with them at gillette. SS joints, but they are small enough.
>
>i think they are the 17K32. since they are SS you can lateral bend them to
>be flexed if you need to, or just fab them to the socket (running from the
>knee center toward the anterior distal end of the socket ) so they stop when
>the knee is still flexed. if you do this, you can probably don't need
>limited ROM, really only flexion is limited. you can get the uprights
>contoured very close to your axis and i think we even turned them upside
>down so we could fab them easily into our sockets. haven't used them in a
>while, just once since i have been here.
-------------------------------------------------------------------------------------------------------------------
>Have you tried an SCSP socket? I would give it a whirl. You might be
>surprised and if it does not work, you can always cut it down and add the J
>& C.
==========================================================
My sincere thanks to all who replied. Not many options in the area of a KO
but hadn't really given much thought to an SCSP design. Will look into that.
Ted A. Trower C.P.O.
A-S-C Orthotics & Prosthetics
Jackson, Michigan, USA
www.amputee.com
Citation
Ted Trower, “Reply summary: pediatric knee orthosis,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 27, 2024, https://library.drfop.org/items/show/220688.
