Amputations in Kids

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January 18, 2013
Edward Smith

Among children, 60 percent of amputations are congenital in nature and 40 percent are acquired due to an injury. Most of these patients require some kind of prosthetic device more so than children who’ve sustained congenital amputations. These acquired amputee children attend specialized child amputee clinics. Acquired amputees are due to trauma most of the time but in a few cases, the limb loss was secondary to disease. The worst offenders are power tools and heavy machinery, followed by automobile accidents, explosions, gunshot wounds and railroad accidents. In the 1-4 age groups, the most common causes of amputation are lawnmowers and household accidents.
Of diseases causing amputation, the most common cause is malignancies, vascular malformations and neurogenic disorders. More than 90 percent of the time, acquired amputations involve just one extremity. In over 60 percent of the cases, the lower limb is the limb affected. Males have more amputations than females at a ratio of 3:2. This is because males tend to engage in activities that are more hazardous than females.
Amputations in kids are similar to amputations in adults. The idea is to save as much limb length as possible, knowing that trauma is the number one cause of these types of surgeries. The limb could be taken off as part of the actual injury or it can be surgically removed because it is salvageable. Some procedures include skin grafting, even over the entire stump and general wound closure so that the stump can accept a prosthesis.

Most kids who need an amputation should have the joint disarticulated. This means the joint is separated as opposed to cutting through the middle of the bone. This preserves the growth plate so the child’s bone is able to grow to the proper length. The loss in length of the bone because the epiphyseal growth plate has been damaged is most likely seen in femur amputations. The epiphyseal growth plate accounts for 70 percent of the total growth of the femur from a young child to age 16.

Complications of an amputation in kids include terminal overgrowth or overgrowth of the immature skeleton of kids at the end of the stump. It occurs most often in the femur, humerus, tibia and fibula. This can mean that the bone penetrates the skin of the stump in some cases. Surgery to cut back the bone needs to happen in 8-12 percent of cases. Recurrences of the problem are common so that surgery has to be done every 2-3 years until the skeleton is mature. Bone spurs can also happen in amputations which necessitates revision of the stump.

In one study, a look at amputation injuries was undertaken for childhood and adolescent amputations. All patients who were 18 or under that had a traumatic amputation over ten years were looked at. There were 74 patients with 77 extremities involved. Forty seven had upper extremity amputations and 30 had lower extremity amputations. They each had an average of 4 procedures done in 2.3 surgeries and stayed in the hospital for 11 days on average. Twenty two percent of patients had lawn mower injuries resulting in amputation. Motor vehicle crashes accounted for sixteen percent of all injuries. Gunshot wound patients stayed in the hospital longer and had more surgeries and more complications. If the limb was attempted to be reattached, 27 of 32 were successful.