Commonly Acquired Lower-Limb Amputations in Children
Acquired lower limb amputations are the result of trauma, tumor, or infection. Traumatic lower limb amputations occur more frequently than traumatic amputations of the upper limb.
These amputations occur secondary to lawn mower, train, motor vehicle, and farming accidents (38-40). Lawn mower accidents often result in partial foot amputations. Train accidents are generally a result of teenagers attempting to board slow-moving trains. The amputations are often high and/or bilateral in nature as a result of the current that draws the youngster under the wheels. Motor vehicle and farming accidents present with varying amputation levels.Meningococcemia and staphylococcal infections with the onset of purpura fulminans can be destructive to the child. If the child is fortunate enough to survive, there are often multiple limb amputations. Lower limb amputations can range from partial foot to transfemoral levels; the most frequent are transtibial levels. Complications due to growth plate arrest, bony overgrowth, and fragile skin may necessitate revision to the knee disarticulation level (63,67).
Both osteogenic and Ewing's sarcoma are more prevalent in the lower limb than in the upper limb. Osteogenic sarcoma tends to have a better survival rate, in that it involves more skeletal than soft tissue structures. Limb salvage techniques and endoprostheses in conjunction with chemical and radiation therapies have often averted the necessity of amputation (45,46,48-50,54,55,129,133-137).
Many lower limb amputations that occur resulting from osteogenic sarcoma are at the transfemoral level, while Ewing's sarcoma tends to migrate more proximally to the region of the upper thigh and pelvis.