Children with short congenital or acquired upper extremity amputations have difficulty with prosthetic fitting. Short below the elbow amputees may be only able to function as if there were above elbow amputees. In addition, short above elbow amputees may be only able to function as shoulder disarticulations. This article attempts to treat these difficult problems with lengthening of the short residual limb to increase prosthetic fitting, and potential usage.
The cohort consists of 11 patients that underwent lengthening of a short upper extremity amputation stump at a single institution. Radiographs and clinical measures were reviewed. A variety of lengthening of devices were utilized. The mean age of surgery was 13.7 years with a range from 6-19 years. There were a variety of reasons for the amputations including trauma and congenial. The stumps lengthening included the humerus in 10 and the ulna in 4.
Nine patients underwent lengthening to improve prosthetic fitting as only 3 were able to be fitted prior to lengthening secondary to the short residual limb. Subsequently, prosthetic fitting was obtained in all after lengthening of the residual limb. The mean bone length increased 75% or 5.5 centimeters. The mean stump length increased 264% or 4 centimeters in those patients in which stump length could be measured preoperatively. Remarkably, 35 additional procedures were required in 10 of 11 patients. These dealt with a variety of complications including fixator adjustments, bone grafting, and tissue transfers to cover the residual limb.
Prosthetic fitting of short upper extremity amputation stumps is difficult and lengthening remains controversial. This study lends support to successful lengthening, however, the high number of subsequent surgeries make this procedure still controversial. The child and family must understand that lengthening of a short residual limb may increase prosthetic fitting, but may incur other surgical procedures to deal with secondary complications. In addition, the larger question remains, whether or whether not lengthening of a residual limb increases prosthetic wear and enhances quality of life?