CHAPTER 30
|
The Child with a Limb Deficiency
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FIGURE 30-35.
A
: Preoperative clinical photograph of a patient with Gillespie type 2 PFFD.
B
: An intraoperative fluoroscopic
radiograph demonstrating the extreme shortening of the femoral segment and lack of any acetabular development.
C
:
Post-
operative clinical photograph after Van Nes rotationplasty.
D
: Postoperatie standing clinical photograph at 1 year of follow-up.
arthrodesis and Syme amputation. In the report of Friscia
et al. (177), one patient subsequently had a Syme amputa-
tion at the parents’ request. Two recent studies evaluating the
quality of life in patients who had rotationplasty for sarcoma
treatment demonstrated that although physical function
was less than that in healthy peers, psychosocial adaptation
and life contentment were about the same (179, 180). This
emphasizes the importance of proper presurgical preparation
of the parents and of the patient, if she or he is old enough.
This is best accomplished by seeing other patients with a rota-
tionplasty, along with the use of videos of patients, teaching
dolls, and so on.
It is imperative that the ankle must be sufficiently normal
to serve as a knee. This is particularly important to determine,
because up to 70% of children with PFFD will also have a
fibular deficiency on the same side. Although some valgus
alignment of the foot and ankle can be compensated for in
the prosthetic alignment, the deformity may progress with age.
Severe valgus and equinus deformities, with a deficient foot,
are contraindications to the procedure.
Additional preoperative preparation includes toe, ankle,
and hindfoot strengthening, in particular, because these are
the structures that will power the new knee joint. Equinus
position should be emphasized, because this will place the
