Claude N. Lambert

The Juvenile Amputee Program: Its Social and Economic Value

The Amputee Clinic at the University of Illinois was established in 1952 arid by February 1968, 2060 amputees had been examined. Of these, 752 were under twenty-one years of age when first seen and had been followed for from four to fifteen years when we undertook the present study to evaluate the results of our Juvenile Amputee Program. In this study two important questions arose: 1. What are we accomplishing socially and economically in the long-term prosthetic treatment of these children? 2. Do the results justify the time, effort, arid expense involved?

Upper-Extremity Prostheses in Juvenile Amputees

Sixty patients under the age of twenty with sixty-seven amputations of the upper extremities have been seen in the Clinic in the past three years. Prostheses have been prescribed and fitted for forty-three, and these patients have received adequate training in the use of the prosthesis. For nine other patients, prostheses have been prescribed and ordered, but they have not yet been received from the manufacturer. Some patients are still too young, being under twenty-two months of age, for a prosthesis. This series does not include patients with partial amputation of the fingers, or those children who have only two digits which could be surgically treated by opposing one to act as a thumb.

The Juvenile Amputee

The Amputee Clinic at the University of Illinois was established in April 1952 with sixteen patients, the majori ty of whom were adults. This special cliuie was set up to bring all of the amputees to one specific clinic where the team approach to the amputee problem could be better utilized. Within the first year we noted an increasing number of Juvenile Amputees and our interest and attention became more oriented to the juvenile problem, so that we rapidly became aware of the Juvenile Amputee as a separate and distinct enti ty from several standpoints. First of all, who should be classified or defined as a Juvenile Amputee ~. We have now arrived at the definition that a Juvenile Amputee is one who is not yet skeletally mature. This matur i ty may be judged from x-rays of epiphyses. Commonly x-rays of the knee are taken, showing the distal femoral and proximal tibial epiphyses. I f the epiphyseal lines are still open, thus denoting further potential growth, the child is still considered a Juvenile. However, if, and when, the epiphyseal lines are closed and growth is no longer a factor, the child is no longer considered a Juvenile and as far as prosthetic fitting is concerned he is comparable to the adult. There are many differences between the juvenile and adult. Perhaps the chief of these is the further growth potential in the child. The iuvenile grows not only longitudinally, but circumferentially. Lengthening of prostheses, particularly in the lower extremity is a routine procedure and any time that the prosthesis becomes more than 1 cm short, lengthening is indicated. This may be necessary as often as each 3 to 6 months. Circumferential growth is checked by socket fit, and new prostheses are needed for this factor every one to 2 years. In the upper extremity, differences in length are not so critical but circumferential fit is even more important for best functional use. The child is really a dependent individual, has few responsibilities, and is quite malleable as far as physical, social and emotional problems are concerned. He is not required to be selfsupporting, and the amputat ion is usually not of economic importance to him at the time of amputation. His vocation and further education can be oriented around his handicap. By comparison, the adult shows a rather fixed[personality, has~ialready been trained both educationally and vocationally and usually is fincancially responsible. An amputat ion in this age group becomes