Growth patterns of lower limbs in children with a traumatic transtibial amputation: A retrospective observational cohort study of anthropometric data from Cambodia.

Abstract

The growth dynamics of the amputated limb are currently unknown for children, affecting prosthetic provision and child's overall wellbeing. The objective of this study was to investigate the growth patterns of the residual limbs of children with a transtibial traumatic amputation. A retrospective observational cohort study of anthropometric data from Cambodia was conducted using casefile of 19 children with a transtibial unilateral traumatic amputation (>100 visits). Anthropometrics of the lower limbs were correlated with age and limb length, and linear regression models were created to predict growth. Residual limb volume changes were estimated using a validated method. The growth rate of the proximal epiphysis of the residual limb was found to be stunted and grew 33.3% slower than would have been expected for typically developing proximal epiphysis growth. This stunted growth can be accurately predicted using the known growth of the contralateral limb (adjusted R2 = 0.743, p < 0.0001, r = 0.864). Residual limb size (girth, bone condylar width) was correlated with age and limb length and can be predicted using linear regression models (girth: adjusted R2 = 0.665, p < 0.0001, r = 0.663 with age and r = -0.338 with limb length; tibial condyle width: adjusted R2 = 0.61, p < 0.0001, r = 0.784). Residual limb percentage volume changes between prosthetic replacements were above the 10% threshold used for prosthetic replacement in adult cohorts over 60% of the cases. This paper found that longitudinal residual limb growth is stunted because of growth plate injury and altered mechanics, paving the way for future research on novel rehabilitation interventions. The regression models developed can help prosthetists and prosthetic manufacturers design prostheses that accommodate growth. These data provide compelling evidence and hard data to prosthetists and manufacturers to better provide for children in this specific setting.