CHAPTER 30
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The Child with a Limb Deficiency
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the SCSP design, except the anterior proximal brim does not
enclose the patella, and therefore allows greater freedom and
range of motion. Contraindications for both the SCSP and
SC design include obese or muscular limbs and patients with
heavy scarring around the knee.
SC cuff suspension is a common form of suspension for
the pediatric transtibial amputee (Fig. 30-48D). The cuff is
fabricated from leather and encompasses the femoral condyles
and patella. It is attached to the medial and lateral aspects of
the socket. The neoprene sleeve suspension is another useful
suspension in the pediatric prosthesis (Fig. 30-48E). For the
very active child, it provides a great level of security in that
the prosthesis will not come off. Recent advances in silicone
and urethane technology have increased comfort, flexibility,
and cosmesis of the sleeve suspension systems.
Silicone suspension liners have become increasingly
popular as a method of suspension without the need for
belts or cuffs (Fig. 30-49). The liner is rolled onto the resid-
ual limb. At the distal end of the liner is a serrated pin.
Inside the distal end of the socket is a shuttle or receptacle
mechanism. Once the liner is donned, the amputee places
the limb in the socket, and the pin and shuttle engage and
lock into place. Pressing of a button hidden on the medial
distal aspect of the prosthesis releases the pin, and the
residual limb can be removed from the socket. Because of
the physical characteristics of the liner, the greater the dis-
tracting forces placed on the prosthesis, the tighter the liner
grips the residual limb. This system is used extensively in
young children. Where space is at a premium, a cushioned
silicone liner used in conjunction with a socket expulsion
valve and a silicone sleeve allows the amputee to achieve
a remarkable level of suspension using a modified suction
technique.
Ankle Disarticulation Prosthesis (Syme).
The obtura-
tor (medial opening) design is most often used when the distal
bulbous end is large and the medial malleolus is prominent
(Fig. 30-50A). The removable or segmented liner socket incor-
porates a full foam liner that has been built up to the same cir-
cumference as the distal bulbous end. A laminated shell is then
formed over this insert. The patient dons the liner first, then
slips this into the laminated receptacle (Fig. 30-50B). An atro-
phied residual limb with a small heel pad is best suited for this
design, and the degree of cosmetic restoration will be very good.
The silicone or bladder prosthesis utilizes an inner elastic area
that stretches to permit the passage of the bulbous end of the
residuum through the narrower circumference of the tibia and
fibula, then constricts once the distal end has passed through
A
B
FIGURE 30-49.
Silicone suspension liners (Triple S
socket) have become very popular. The soft silicone
liner has a serrated pin incorporated into the bottom of
the liner. The patient rolls the liner on the residual limb
(A)
, then inserts the limb into the prosthesis
(B)
. At the
bottom of the prosthesis is a socket in which the pin
locks. It is released by pushing the button on the medial
side of the prosthesis.
