Responses: PFFD

Responses: PFFD

Thanks to all who responded to my recent inquiry concerning a PFFD patient.
Below is my original post followed by the responses received. I will be
sharing this well informed and much appreciated advice with the parents and we
will proceed from there. My recommendation will be to begin with the second
opinion for a surgical consult ASAP. Kudos again to this great resource and its
participants.
 
 
 
 
 
 
 
Sincerely,
Eddie
 

Original Post:
 
We are looking for recommendations for prosthetic fitting of 9 yr. old PFFD.
This patient has a short femur, approximately seven inches, with an
undeveloped hip joint and a sharp spike instead of a ball at the proximal femur.
The femur displaces dramatically upward and into abduction and flexion on
weight bearing. Still, there is more active ROM at the hip than any PFFD I have
worked with. The knee is quite high but appears nearly normal with very good
ROM. The patient can ambulate quite quickly without any prosthesis but he does
have pain at the hip and considerable soreness for a day or two following
periods of high activity (with or without the prosthesis). The patient
currently has a non-articulating prosthesis that is too small in the proximal socket.
The patient is sitting on a lot of tissue proximally with the ischial
tuberosity and ramus riding well above the socket brim. The prosthesis holds the
foot very platarflexed and the knee joint very straight (extended). The mother
really wants a prosthesis that will bend so they can get in and out of cars,
under the table at restaurants, etc., more easily.
 
 

My first choice would be an ischial containment socket with external joints
at anatomical knee center. However, the femur is so short and the knee joint
is just so far proximal that I'm afraid that placing the joints there with a
socket proximally will result in a socket too short to obtain the
stabilization needed and an extremely long (perhaps unruly) shin section below the
knee. Also, the mother does not like this option because she is afraid that it
will be awkward and cause him to be very asymmetrical when sitting.
 
Another choice is to place the joints closer to sound side anatomical knee
center and allow the foot to extend out, in this case well past the external
joints. If I keep him extended at the knee and hip there is only about a 6-7
inch shortage from toe tips to the floor. If I flex the hip, knee and foot a
bit I will be able to make this type of prosthesis somewhat more cosmetic and
hopefully more practical when bending the knee (flexing the external knee
joints and shin section) while wearing cloths. Is there any contraindication
to building this type of prosthesis with hip, knee and foot flexed somewhat?
 
Are there other Ideas I may have not considered?
 
Finally, the surgeon has told the parents that they should wait until he is
16 or 17 to consider any type of surgery. Is there any reason to think
otherwise and where is the best place to get information on the most recent and
most successful surgical procedures for this type of PFFD patient.