Hemipelvectomy and toddlers
Christina Skoski M.D.
Description
Collection
Title:
Hemipelvectomy and toddlers
Creator:
Christina Skoski M.D.
Date:
8/18/2003
Text:
Greetings to all,
Via my web site for the high level amp, I received the following.....this
is way beyond my capabilities so
I'm posting this challenging case (in edited form) from a non member
prosthetist in hopes some of you may have some suggestions. I'll post the
answers and forward them to the CP in question. Thanks.
I am a prosthetist in Canada with 13 years experience......
I have an 11 month old client with a congenital hemipelvectomy
amputation. he's anatomically a text book HP and does have all the
non-bony gluteal structures. He has a large amount of soft tissue on the
amputated side and remaining musculature, such that he looks like a
HD. There are no other known congenital abnormalities. He
has had a prosthesis since 8 months old (provided by
another prosthetist with no experience either!) and started using it
primarily with the physiotherapist. The peds Otto Bock hip joint was added
at age 10 months and wearing time was increased by Mom and Dad while physio
continued. At ten months he was able to pull to stand (with and with out
the prosthesis) with only minor assistance and was able to balance
independently in front of a chair while playing with toys which also caused
him to stretch to reach different objects. Today at 11 months he can pull
to stand and can shuffle along
the chair while playing with objects. He has figured out a way to crawl as
fast as any one year old I've seen (one legged or two) and was able to dump
a ten pound basin of water I was using to cast him when the adults had their
attention elsewhere. Of course we were proud!
Recently it has become increasingly difficult to keep the leg suspended and
it would appear that this is a result of the socket being too shallow (trim
line now below the iliac crest on the contralateral side) but this may be a
symptom of a growth spurt.
Questions:
1. How to attain and maintain adequate suspension on a growing, active
child hemipelvectomy?
2. How to make a good cast on a squirmy toddler without making it a
traumatic experience for either the practitioner or the child?
3. How high should the socket be? Any concerns or comments about
encasing the ribs, breathing problems and/or the prevention of scoliosis.
4. Would consulting an orthotist with scoliosis experience be in order
for future casting techniques?
5. Cast with or without the diaper?
6. Another casting and socket modification
assumption I have is that I should incorporate the contralateral gluteal
area to distribute weight bearing.
Thank you in advance for your help.
Kirsten Simonsen, BSc, CP(c)
Certified Prosthetist
Sincerely yours,
Christina Skoski MD
www.hphdhelp.org
<Email Address Redacted>
Via my web site for the high level amp, I received the following.....this
is way beyond my capabilities so
I'm posting this challenging case (in edited form) from a non member
prosthetist in hopes some of you may have some suggestions. I'll post the
answers and forward them to the CP in question. Thanks.
I am a prosthetist in Canada with 13 years experience......
I have an 11 month old client with a congenital hemipelvectomy
amputation. he's anatomically a text book HP and does have all the
non-bony gluteal structures. He has a large amount of soft tissue on the
amputated side and remaining musculature, such that he looks like a
HD. There are no other known congenital abnormalities. He
has had a prosthesis since 8 months old (provided by
another prosthetist with no experience either!) and started using it
primarily with the physiotherapist. The peds Otto Bock hip joint was added
at age 10 months and wearing time was increased by Mom and Dad while physio
continued. At ten months he was able to pull to stand (with and with out
the prosthesis) with only minor assistance and was able to balance
independently in front of a chair while playing with toys which also caused
him to stretch to reach different objects. Today at 11 months he can pull
to stand and can shuffle along
the chair while playing with objects. He has figured out a way to crawl as
fast as any one year old I've seen (one legged or two) and was able to dump
a ten pound basin of water I was using to cast him when the adults had their
attention elsewhere. Of course we were proud!
Recently it has become increasingly difficult to keep the leg suspended and
it would appear that this is a result of the socket being too shallow (trim
line now below the iliac crest on the contralateral side) but this may be a
symptom of a growth spurt.
Questions:
1. How to attain and maintain adequate suspension on a growing, active
child hemipelvectomy?
2. How to make a good cast on a squirmy toddler without making it a
traumatic experience for either the practitioner or the child?
3. How high should the socket be? Any concerns or comments about
encasing the ribs, breathing problems and/or the prevention of scoliosis.
4. Would consulting an orthotist with scoliosis experience be in order
for future casting techniques?
5. Cast with or without the diaper?
6. Another casting and socket modification
assumption I have is that I should incorporate the contralateral gluteal
area to distribute weight bearing.
Thank you in advance for your help.
Kirsten Simonsen, BSc, CP(c)
Certified Prosthetist
Sincerely yours,
Christina Skoski MD
www.hphdhelp.org
<Email Address Redacted>
Citation
Christina Skoski M.D., “Hemipelvectomy and toddlers,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 25, 2024, https://library.drfop.org/items/show/221570.
