Tag Archive for: Amputation

Management of Limb Deficiencies

Volume 10 | Issue 2 | May-August 2024 | Page: 48-54 | Sakti Prasad Das, Sankar Ganesh, Prateek Behera

DOI- https://doi.org/10.13107/ijpo.2024.v10.i02.194

Submitted: 11/03/2024; Reviewed: 08/04/2024; Accepted: 25/06/2024; Published: 10/08/2024


Authors: Sakti Prasad Das MS(Ortho.), DNB(PMR) [1], Sankar Ganesh MPT [2], Prateek Behera MS(Ortho.), DNB(Ortho.) [3]

[1] Medical Education & Training, DRIEMS University, Odisha, Tangi, Cuttack, Odisha, India.
[2] Department of Physiotherapy, Composite Regional Centre, Lucknow, Uttar Pradesh, India.
[3] Department of Orthopaedics, AIIMS Bhopal, Madhya Pradesh, India.

Address of Correspondence

Dr. Sakti Prasad Das,
Director, Medical Education & Training, DRIEMS University, Odisha, Tangi, Cuttack, Odisha, India.
E-mail: sakti2663@yahoo.com


Abstract

Limb deficiency disorders encompass a wide variety of congenital anomalies that have a significant underdevelopment or even complete absence of bones in the limbs. Treatment of these conditions must be holistic with the child at the centre. This article provides a review of the current understanding of the management of such conditions. Surgical treatment offers a practical and effective solution for treating many variants of congenital limb abnormalities. Although novel surgical treatments may expand the range of disorders that can be treated, it is crucial for both the surgeon and the family to be aware of the careful prognosis associated with the methods used. Additionally, the importance of an amputation as an option should always be kept under consideration.
Keywords: Amputation, Congenital Abnormalities, Deformity correction, Limb reconstruction, Pediatric skeletal deficiencies, Skeletal dysplasia


References

1. WHO. Congenital disorders. Geneva: WHO, 2023. Available: https://www.who.int/news-room/fact-sheets/detail/birth-defects
2. Moges N, Anley DT, Zemene MA, Adella GA, Solomon Y, Bantie B, et al. Congenital anomalies and risk factors in Africa: a systematic review and meta-analysis. BMJ paediatrics open, 2023;7(1), e002022. https://doi.org/10.1136/bmjpo-2023-002022
3. WHO. International statistical classification of diseases and related health problems (ICD)-11. Geneva WHO. 2023. Available: https://www.who.int/classifications/classification-of-diseases
4. Epps CH Jr. Proximal femoral focal deficiency. J Bone Joint Surg Am 1983; 65: 867–70.
5. Kakarla S. Proximal femoral focal deficiency (PFFD) imaging spectrum. J Med Sci Res. 2015;3(2):90–93. doi: 10.17727/JMSR.2015/3-018
6. Paley D, Guardo F. Lengthening reconstruction surgery for congenital deficiency. In: Kocaoglu M, Tsuchiya H, Eralp L, editors. Advanced techniques in limb reconstruction surgery. 2014. pp. 245–298.
7. Gupta SK, Alassaf N, Harrop AR, Kiefer GN. Principles of rotationplasty. J Am Acad Orthop Surg. 2012;20:657–667. doi: 10.5435/JAAOS-20-10-657
8. Ackman J, Altiok H, Flanagan A, Peer M, Graf A, Krzak J, et al. Long-term follow-up of Van Nes rotationplasty in patients with congenital proximal focal femoral deficiency. Bone Joint J. 2013;95-B(2):192–198. doi: 10.1302/0301-620X.95B2.30853
9. Jones D, Barnes J, Lloyd-Roberts GC. Congenital aplasia and dysplasia of the tibia with intact fibula. Classification and management. J Bone Joint Surg Br. 1978;60(1):31-39. doi:10.1302/0301-620X.60B1.627576
10. Kalamchi A., Dawe R.W. Congenital deficiency of the tibia. J. Bone Jt. Surg. Br. 1985;67:581–584. doi: 10.1302/0301-620X.67B4.4030854
11. Weber M. New classification and score for tibia hemimelia. J Child Orthop. 2008;2:169–175.
12. Fernandez-Palazzi F, Bendahan J, Rivas S. Congenital deficiency of the tibia: a report on 22 cases. J Pediatr Orthop B. 1998;7:298–302.
13. Epps C.H., Jr., Schneider P. Treatment of hemimelias of the lower extremity. Long–term results. J. Bone Jt. Surg. Am. Vol. 1989;71:273–277. doi: 10.2106/00004623-198971020-00015
14. Putti V. The treatment of congenital absence of the tibia or fibula. Chir. Org. Mov. 1929;7:513.
15. Paley D. Surgical reconstruction for fibular hemimelia. J. Child. Orthop. 2016;10:557–583. doi: 10.1007/s11832-016-0790-0
16. Paley D., Robbins C. Fibular hemimelia Paley type 3. In: Rozbruch S.R., Hamdy R., editors. Limb Lengthening and Reconstruction Surgery Case Atlas. 1st ed. Springer International Publishing; Cham, Switzerland: 2015. pp. 1–8.
17. Johnson CE, Haideri NF. Comparison of functional outcome in fibular deficiency treated by limb salvage versus Syme’s amputation. In: Herring JA, Birch JG, eds. The Child With a Limb Deficiency. Rosemont: American Academy of Orthopaedic Surgeons; 1998: 173–177.
18. Herzenberg J., Shabtai L, Standard SC. Fibular hemimelia: Principles and techniques of management. In: Sabharwal S., editor. Pediatric Lower Limb Deformities, Principles and Techniques of Management. 1st ed. Springer International Publishing; Cham, Switzerland: 2016. pp. 427–454.
19. Birch JG, Lincoln TL, Mack PW, et al. Congenital fibular deficiency: a review of thirty years’ experience at one institution and a proposed classification system based on clinical deformity. J Bone Joint Surg Am. 2011;93:1144–1151.
20. Ali S, Kaplan S, Kaufman T, Fenerty S, Kozin S, Zlotolow DA. Madelung deformity and Madelung-type deformities: a review of the clinical and radiological characteristics. Pediatr Radiol. 2015;45(12):1856-1863. doi:10.1007/s00247-015-3390-0
21. Nielsen JB. Madelung’s deformity. A follow-up study of 26 cases and a review of the literature. Acta Orthop Scand. 1977;48(4):379-384. doi:10.3109/17453677708992012
22. Farr S, Martinez-Alvarez S, Little KJ et al (2021) The prevalence of Vickers’ ligament in Madelung’s deformity: a retrospective multicentre study of 75 surgical cases. J Hand Surg Eur. https://doi. org/ 10. 1177/ 17531 93420 981522
23. Vickers D, Nielsen G. Madelung deformity: surgical prophylaxis (physiolysis) during the late growth period by resection of the dyschondrosteosis lesion. J Hand Surg Br. 1992;17(4):401-407.
24. Laffosse JM, Abid A, Accadbled F, Knör G, de Gauzy JS, Cahuzac JP. Surgical correction of Madelung’s deformity by combined corrective radioulnar osteotomy: 14 cases with four-year minimum follow-up. IntOrthop. 2009; 33: 1655-1661.
25. Steinman S, Oishi S, Mills J, Bush P, Wheeler L, Ezaki M. Volar ligament release and distal radial dome osteotomy for the correction of Madelung deformity: long-term follow-up. J Bone Joint Surg Am. 2013;95(13):1198-1204. doi:10.2106/JBJS.L.00714
26. Colen DL, Lin IC, Levin LS, Chang B. Radial longitudinal deficiency: recent developments, controversies, and an evidence-based guide to treatment. J Hand Surg Am. 2017 Jul;42(7):546-563. https://doi.org/10.1016/j.jhsa.2017.04.012
27. Bednar MS, James MA, Light TR. Congenital longitudinal deficiency. J Hand Surg Am. 2009 Nov;34(9):1739-1747. https://doi.org/10.1016/j.jhsa.2009.09.002
28. Stutz C, Oishi S. Radial longitudinal deficiency: radius hypoplasia. In: Laub Jr DR, ed. Congenital Anomalies of the Upper Extremity. New York: Springer; 2015:85-94.
29. Takagi T, Seki A, Mochida J, Takayama S. Bone lengthening of the radius with temporary external fixation of the wrist for mild radial club hand. J Plast Reconstr Aesthetic Surg. 2014;67:1688e1693. https://doi.org/10.1016/ j.bjps.2019.05.044
30. Buck-Gramcko D. Radialization as a new treatment for radial club hand. J. Hand Surg. Am. 1985;10(6 Pt 2):964–968. doi: 10.1016/S0363-5023(85)80013-7
31. Wall LB, Ezaki M, Oishi SN. Management of congenital radial longitudinal deficiency: controversies and current concepts. Plast Reconstr Surg. 2013 Jul;132(1):122-128.
32. Cole RJ, Manske PR .Classification of ulnar deficiency according to the thumb and first web.. J Hand Surg Am. 1997;22:479–488.

 


How to Cite this Article:  Das SP, Ganesh S, Behera P | Management of Limb Deficiencies | International Journal of Paediatric Orthopaedics | May-August 2024; 10(2): 48-54. https://doi.org/10.13107/ijpo.2024.v10.i02.194

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Amputation Following Meningococcal Septicaemia in Children: the Surgical Management of the Residual Limb

Volume 4 | Issue 2 | July-December 2018 | Page: 20-26 | Brigid M. Aherne, Fergal P. Monsell

DOI- 10.13107/ijpo.2018.v04i02.014


Authors: Brigid M. Aherne, Fergal P. Monsell [1]

 

Medical Student, University of Bristol, [1] Consultant Orthopaedic Surgeon, Bristol Royal Hospital for Children, Bristol, England, United Kingdom.

Address of Correspondence
Mr. Fergal P. Monsell,
Bristol Royal Hospital for Children, Upper Maudlin St, Bristol BS2 8BJ, England, United Kingdom.
E-mail: Fergal.Monsell@UHBristol.nhs.uk


Abstract

Background: Meningococcal septicaemia is a potentially life-threatening disease and remains the most common infective cause of mortality in the UK. Improvements in healthcare have led to early recognition and treatment, and a decrease in mortality. As more children now survive the initial acute illness, the long-term musculoskeletal consequences have become more prevalent. These include growth plate injury, tissue loss and amputation. Patients with limb loss present specific difficulties due to the effect of remaining longitudinal growth on the function of the residual limb, and often require surgical treatment that continues throughout childhood.
Patients and Methods: This case series reviews the histories of 13 children who underwent amputation as a complication of meningococcal septicaemia. All patients attend a specialist clinic and our experience in the management of the residual limb is described.
Results: Thirteen patients, with a mean age of 16 months at the onset of meningococcal septicaemia, required amputation in the management of the skeletal consequences of the infection. Revision surgery was necessary for all 13 patients and involved management of bone overgrowth, growth arrest, scar and soft tissue contracture, neuroma development, and infection. The details of our approach to each of these complications is described.
Conclusion: Due to improvements in diagnosis and initial management, a significant proportion of patients are surviving infantile meningococcal septicaemia. Many develop musculoskeletal consequences including amputation, and this case series serves to increase knowledge in the complex managements of the residual limb in these patients.
Keywords: Amputation, meningococcal septicaemia, residual limb


References 

1. Paize F, Playfor SD. Improvements in the outcome of children with meningococcal disease. Crit Care 2007;11:172.
2. Maat M, Buysse CM, Emonts M, Spanjaard L, Joosten KF, De Groot R, et al. Improved survival of children with sepsis and purpura: Effects of age, gender, and era. Crit Care 2007;11:R112.
3. Nectoux E, Mezel A, Raux S, Fron D, Maillet M, Herbaux B. Meningococcal purpura fulminans in children: I. Initial orthopedic management. J Child Orthop 2010;4:401-7.
4. de Kleijn ED, Hazelzet JA, Kornelisse RF, de Groot R. Pathophysiology of meningococcal sepsis in children. Eur J Pediatr 1998;157:869-80.
5. Davies MS, Nadel S, Habibi P, Levin M, Hunt DM. The orthopaedic management of peripheral ischaemia in meningococcal septicaemia in children. J Bone Joint Surg Br 2000;82:383-6.
6. Belthur MV, Bradish CE, Gibbons PJ. Late orthopaedic sequelae following meningococcal septicaemia. J Bone Joint Surg Br 2005;87:236-40.
7. Booy R, Habibi P, Nadel S, de Munter C, Britto J, Morrison A, et al. Reduction in case fatality rate from meningococcal disease associated with improved healthcare delivery. Arch Dis Child 2001;85:386-90.
8. Monsell FP, McBride AR, Barnes JR, Kirubanandan R. Angular deformity of the ankle with sparing of the distal fibula following meningococcal septicaemia: A case series involving 14 ankles in ten children. J Bone Joint Surg Br 2011;93:1131-3.
9. Monsell F. The skeletal consequences of meningococcal septicaemia. Arch Dis Child 2012;97:539-44.
10. Nectoux E, Mezel A, Raux S, Fron D, Klein C, Herbaux B. Meningococcal purpura fulminans in children. II: Late orthopedic sequelae management. J Child Orthop 2010;4:409-16.
11. Park DH, Bradish CF. The management of the orthopaedic sequelae of meningococcal septicaemia: Patients treated to skeletal maturity. J Bone Joint Surg Br 2011;93:984-9.
12. Buysse CM, Oranje AP, Zuidema E, Hazelzet JA, Hop WC, Diepstraten AF, et al. Long-term skin scarring and orthopaedic sequelae in survivors of meningococcal septic shock. Arch Dis Child 2009;94:381-6.
13. Nogi J. Physeal arrest in purpura fulminans − A report of 3 cases. J Bone Joint Surg Am 1989;71:929-31.
14. Wheeler JS, Anderson BJ, De Chalain TM. Surgical interventionsin children with meningococcal purpura fulminans − A review of 117 procedures in 21 children. J Pediatr Surg 2003;38: 597-603.
15. Grogan DP, Love SM, Ogden JA, Millar EA, Johnson LO. Chondro-osseous growth abnormalities after meningococcemia − A clinical and histopathological study. J Bone Joint Surg Am 1989;71:920-8.


How to Cite this Article:  Aherne BM, Monsell FP | Amputation Following Meningococcal Septicaemia in Children: the Surgical Management of the Residual Limb | July-December 2018; 4(2): 20-26.
 

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