CHAPTER 30
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The Child with a Limb Deficiency
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Suction sockets are not typically used for the pediatric
population because of tight tolerances in fitting that cannot be
maintained by a growing child. With the suction socket, the
residual limb is pulled into a socket that incorporates a one-
way valve in its design (Fig. 30-47). Once the valve is in place,
the amputee expels air every time the prosthesis is in contact
with the ground. During swing phase, the negative pressure
within the socket holds the prosthesis in place. Air that leaks
into the socket is quickly expelled through the one-way valve,
and a constant negative pressure is maintained. Total contact
suction sockets are generally used for the transfemoral amputee
with a mature residual limb and at the completion of skeletal
growth. Short limbs, volumetric changes, and severe scarring
are contraindications for the suction-suspended socket.
Transtibial Prosthesis.
The transtibial prosthesis is used the
least in the pediatric population. Although most amputations in
children are disarticulations, growth changes in the fibular defi-
ciency often result in a transtibial-level residual limb that is a dis-
tal-end weight-bearing limb. The true transtibial socket is most
often required for the traumatic amputee. Total contact design
allows for increased pressure bearing over the patellar tendon,
medial flare of the tibia, medial shaft of the tibia, and lateral
shaft of the fibula, and the anterior and posterior compartments.
A
B
FIGURE 30-46.
The nonconven-
tional or extension prosthesis allows
the child to “stand” on the prosthe-
sis, extending his limb to the floor
and accommodating the deformity.
A,B
: The nonconventional or exten-
sion prosthesis without a knee joint,
which is usual. It is possible to add a
knee joint to the prosthesis.
A
B
FIGURE 30-47.
Methods of suspension for
transfemoral prostheses.
A
: The Silesian belt is
almost universally used in the young pediatric
patient to suspend a transfemoral prosthesis or
occasionally a knee disarticulation or transtibial
prosthesis.
B
: The suction socket is a tight-fitting
socket design with a one-way valve that allows
air to be expelled with weight bearing to main-
tain a suction fit on the residual limb. It is best
suited for the older child or adolescent, who has
a mature limb that is not changing in size.
