Rehabilitologists and prosthetists agree that if prosthetics are necessary, the sooner it is performed, the easier it will be for the child to get used to it and start using it, if not as a “native” limb, then with confidence. The main difficulty in children’s prosthetics, which applies to absolutely all types of prosthetic products, is the rapid growth of the child.

In this regard, prostheses have to be changed quite often – until the end of the active growth phase, on average, once a year.

This fact, as well as the peculiarities of children’s anatomy, require the careful involvement of a prosthetist at all stages of the process of selection, fitting and rehabilitation.

The level of amputation is determined by the nature and localization of the lesion, as well as the level of tissue viability and the presence of concomitant diseases. The regenerative abilities of a child’s body are higher than those of an adult, and this is taken into account when planning rehabilitation measures and subsequent prosthetics. It is necessary to create conditions for recovery that would maximize normal healing. For example, it is necessary to prevent the formation of adhesions between the bone and the scar, especially near the joints. This can cause deformation of the stump and complicate prosthetics.

Considerable attention during prosthetics is also paid to the selection and fitting of the receiving sleeve. It should be formed taking into account the child’s anatomy, the level of prosthetics and the condition of the scar. A promising area in pediatric prosthetics is the use of demineralized grafts, which are used to expand the lower part of the stump, prevent bone ingrowth into soft tissue and stimulate bone growth. Such grafts look like a sleeve that is put on the end of the stump and fixed with pins. It stimulates stump thickening and does not injure soft tissues.

In principle, all types of limb prostheses used for adults are also suitable for children – adjusted for anatomy and size. These can be:

• cosmetic;
• functional-cosmetic;
• functional prostheses;
• traction prostheses;
• bionic with an external power supply.

The first type is suitable only as a cosmetic limb replacement and performs a limited number of functions. The second type – are a transitional option between fully functional prostheses and cosmetic prostheses, they allow, for example, walking. Working prosthetic hands are equipped with removable hands for replacement with various tools and devices depending on the type of activity.

Traction prostheses can be controlled by the user’s muscle strength, which is transmitted to a complex system of rods. They are much more functional than the previous types, but have peculiarities when used in pediatric prosthetics because children’s muscles are usually not yet sufficiently developed. Such a prosthesis requires some time to master, but allows you to return to almost the same level of activity.

However, active traction prostheses are considered to be the most suitable for children aged 2 to 10 years due to their light weight and cost with a wide range of functions. With such a prosthesis, the child remains active, which is extremely important for the formation of a healthy foundation for future life. He or she does not feel the disability and is not ashamed of it, which is also important for the process of normal socialization and communication with peers. A traction prosthesis can also be considered as a training prosthesis before the subsequent installation of a bionic prosthesis.

Traction prostheses for children have a modular system, which makes it possible to partially compensate for the child’s growth by changing the length of individual joints. Modular prostheses are assembled from individual standard parts, the length of which can be changed depending on the height and proportions of the user, which is very suitable for pediatric prosthetics.
Bionic prostheses due to their rather high cost, it is better to install them after the end of the active growth phase, although they can be installed after reaching 10-12 years of age. The bionic prosthesis has servo drives that are activated and controlled by nerve impulses transmitted to special sensors. Mastering such a prosthesis also takes time, but they provide the maximum level of comfort.

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