Case Report-A Combined Expertise of Orthopaedics, Prosthetics and Orthotics in the Management of a Child with Cloacal Exstrophy


Unusual cases that require the combined expertise of prosthetists and orthotists using refined materials is rare. We have had occasion to treat a child with cloacal exstrophy with major orthopaedic involvement. She was born with the usual stigmata of exstrophy necessitating iliac osteotomies at birth. She had a complete tibial hemimelia on the right leg and a rigid talipes equinovarus on the left. She underwent a right through knee disarticulation and posteromedial release of her left club foot and tibial osteotomy.

She has a lipomeningocele with L-2 as the last functioning neurological level. The combined efforts of orthopaedic surgery, prosthetics and orthotics was required in conjunction with physical and occupational therapy. As part of the Meningomyelocele Clinic our philosophy is for vigorous attempts at standing and mobilization. To meet this requirement this patient had a right above knee prosthesis fabricated. This was done in conjunction with the application of a reciprocating gait orthosis (RGO). The combination of motor paralysis and insensitive skin coupled with an amputation has demonstrated the required combined knowledge of innovative orthotic and prosthetic techniques.

British Columbia Children's Hospital, 210-650 W 41st Avenue, South Tower, Vancouver, BC, Canada V6H 3K2