10). “I have been working closely with a Pediatric Orthopedist for some =
time now and would recommend the possible Symes amputation with the =
following provisions, check the height of the patient against parents =
and siblings, is further surgery opposed by the parents, general size =
and activity levels
of the family. If good growth potential is possible, the Symes can be =
done and the growth plates can be sealed now, or at a later date, so =
that the patient ends up with a good BK length, along with distal end =
bearing, but the prosthetist still has room to adapt several components =
in the future as she grows to
adulthood. This procedure sometime requires several surgeries over many =
years to stop further growth, so it is important that the parents be =
well informed.
Timing is critical, but outcome can be excellent.”
-Steve Dickerson, CP
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11). “This is a hard one. I have manufactured both, and if done =
properly(surgery) both can give sound prosthetics functionally. However, =
the chopart amp creates big problems for cosmesis. As this is a female =
amputee I suggest you think about her teenage years, as at puberty this =
is when the cosmetic appearance will become all important for self =
perception. I have found that it is very very difficult to obtain a =
reasonable cosmesis with a Chopart amp.
Other side of the coin of course, is that a symes with a split liner is =
not
so great either.
A symes I feel is a better level, as when the patient grows, there will =
be
some shortening of the limb, and a better cosmesis can be achieved, as =
the
bone structure below the joint is removed.Please do not ask to have the
medio-lateral maleolii shaved. This loses suspension capability.
(trim distally) But im sure the surgeon will know this.”
-Peter A Lewis CCPO Townsville Australia.
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12). “With a chopart the calcaneous is intact which will preserve limb =
length, the problem with that is that this extra length limit’s the =
prosthetist’s
options with foot selection. With a properly performed symes amputation =
the calcaneous is removed and the keel pad is attached distally =
providing a good weight bearing surface and allowing more space for the =
foot.
Foot selection for a chopart is limited to the Springlite chopart carbon
foot plate. With a syme;s there is a large selection of feet available. =
We
have A LOT of symes amputees and very few problems with distal =
breakdown.”
-Brian Pinkston C.P., L.P.
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13). “As u have asked about the level of amputation and its usefulness=20
,in my opinion its better to go for a symes amputation or a B/K=20
amputation depends on the activities of the amputee. in symes=20
amputation there is a little bit problem in fitment of prosthetic=20
foot but as the client grows her activities will certainly=20
increses and that time u have more problem in foot replacement so=20
if u can then convince the parents to go for a good B/K amputation=20
and u can gave her more freedom of walking , running and=20
independence in her life . As u know there are so many type of=20
dynamic foot that u can fit to an ideal B/K prosthesis . Because=20
the amputee is child so the adaptation will be easy .”
-Dewendra Prasad
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14). “I would suggest you contact some of the Shriner’s hospitals =
around. I’m familiar with Scottish Rite in Dallas and get similar advice =
from them on occasion. You should be able to get the best info and =
experience through them.
I’ve worked with a few Chopart patients who had surgeries as children =
and are now in their 60’s. Chopart seems to be preferable as it permits =
full=20
weight-bearing, presents a more stable distal end, maintains normal limb =
length, and can be more cosmetic. The drawbacks are that an excellent=20
surgical technique is required to modify tendon insertions and give =
padding=20
to distal bone. Otherwise the sure result will be a plantar flexion=20
contracture and excessive distal pressure leading to breakdown.
Were it my child I would give serious thought to a BK level after =
consulting an orthopedist regarding the consequences for bone growth.”
-Dave Gross CP
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15). “I do not know what the current amputation is like. However, once =
an amputation is done, there is no going back. At this age growth =
plates would be interrupted, causing a shortened limb as the child =
grows. From a functional stand point a symes or chopart is good but she =
is only 9 years old. While she is growing there will be routine =
replacement on her symes prosthesis; this is also true with a true =
chopart, but not as often. Unless the present amputation is very =
unusual you may want to stay with the chopart. You can always remove =
more. Again, I do not know all the specifics so this is all I can say. =
I have worked with a lot of children and almost all the time the =
children do well with most levels of lower limb amputations; therapy and =
home and clinical support is important. Sorry there is not a united =
front on this. Milwaukee children’s hospital use to have an excellent =
amputee clinic. Dr. Al Kritter, Sr. and Dr. Bolt used to manage it. =
Dave Schultz, CPO was involved with the clinic itself for many years.”=20
-Robert L Hrynko, CPO
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Thank you for sharing this wealth of knowledge!!
Monica Motloch, CO, Prosthetic Resident
