Prosthetic Considerations for PFFD
DAN ROWE, CPO*
Children with proximal femoral focal deficiency present stable volume and good skin and muscle tone. In Types A, and sometimes B, the hip is stable enough for acceptable gait. Ischiogluteal and lateral support from the socket may be aided by a Silesian bandage. In Types C and D, the hip is completely unstable; vertical loads are applied via the ischium and soft buttock tissues with a "ship's funnel" socket. Trimlines depend on the amount of rotational control required and the need for a high attachment for the Silesian bandage which aids lateral stability. Anterior thigh bowing may be used for suspension, especially if the knee is close to the hip. If the foot has been ablated, suspension may be accomplished by a self-suspending socket or polyethylene foam inserts used. If the foot is present, elastic-laced rubber or Velcro with the Silesian bandage suffices. With Van Nes rotationplasty, a thigh lacer may be installed.
Alignment depends on the extent of hip stability. Components vary because some patients are fitted as above-knee amputees, while others have below-knee-type prostheses. Selection is limited by the children's small size. The four-bar linkage knee system facilitates efficient gait, but single-axis above-knee units and below-knee outside joints are alternatives. Most have SACH feet. Socket materials may be flexible, rigid, foam, or leather.
*2032 Marshall Avenue, Saint Paul, MN 55104