1102 - A Multidisciplinary Care Model for Children with Lower-Limb Amputations

Case Diagnosis: Patient 1 is a 9-year-old male diagnosed with fibular hemimelia, a congenital limb difference, at a young age.

Patient 2 is an 18-year-old male who sustained a traumatic injury to the right foot overseas at 15-years-old.

Case Description: Patient 1 presented at 3-years-old and was recommended a Boyd amputation of the right lower limb. Postoperatively, he was fitted with a prosthesis that has a window and door closure. By age 9, he developed right lower extremity genu valgus malalignment and underwent medial hemi-epiphysiodesis of the right distal femur and epiphysiodesis of the right proximal tibia to better accommodate future prosthesis components. Routine mental health screenings later revealed elevated mood concerns. Psychology provided psychoeducation and community referrals.

Patient 2 arrived with a degloving/crush injury to the right foot and a complex polymicrobial infection, necessitating multiple irrigation and debridement procedures. Ultimately, a transtibial amputation was performed, and he subsequently underwent prosthetic training as an inpatient and in a day rehabilitation program. Soon after, he exhibited symptoms consistent with Acute Stress Disorder. Treatment included psychoeducation, relaxation exercises, cognitive restructuring, and exposure therapy.

Discussions: Children with lower-limb differences have evolving physical and emotional needs due to growth and development. Regardless of the patient’s age or type of amputation, a multidisciplinary approach is crucial for providing comprehensive care. At our hospital, the care team includes a prosthetist, orthopedic surgeon, physiatrist, physical and occupational therapists, psychologist, and child-life specialist.

This model aims to optimize care and properly address patients’ changing needs during each stage of their prosthetic rehabilitation: pre-amputation, immediate post-amputation, functional rehabilitation, and long-term maintenance. Using this staged and multidisciplinary approach helps enhance communication, expedite necessary interventions, and address gaps in patient/family counseling.

Conclusions: Through these two cases, we will demonstrate the multidisciplinary team’s roles during each rehabilitation stage, highlighting the benefits of this comprehensive care model.