Management of proximal femoral focal deficiency with limited resources in Haiti

Abstract

Background: Individuals with proximal femoral focal deficiency (PFFD) present with a shortened femur. This report highlights the process used to determine prosthetic candidacy, a novel use of the International Committee of the Red Cross (ICRC) prosthetic materials, and subsequent rehabilitation when treating in rural Haiti. Case Description and Methods: An eight-year-old boy with PFFD whose goal was to walk 'normally' presented with a shortened right leg and typical foot/ankle. Concerns regarding ability to safely load the leg were mitigated after finding he could fully load his right limb, control motion, and had no fractures. Findings and Outcomes: A unique prosthosis incorporating a donated hinged ankle-foot orthosis, ICRC materials and a SACH foot was fabricated. Physical therapy followed for two weeks, progressing from static weight-bearing and gait training to dynamic balance activities. At discharge, the patient walked independently using the prosthosis and one forearm crutch. Conclusion: Through collaboration and innovation rehabilitation goals can be realized even when presented with limited resources. Clinical relevanceThrough collaboration and innovation novel prosthetic designs incorporating materials from the International Committee of the Red Cross can be created and rehabilitation goals can be realized even when presented with limited resources.

Proximal femoral focal deficiency – a rare congenital entity: two case reports and a review of the literature

“…This is done irrespective of any intended future management as the initial treatment should synchronize with normal development. This acts as a stop gap while waiting for the child to reach an appropriate age for surgery or between episodes of surgical treatment [25].…”

“…Limb modification surgery for PFFD includes Van Nes rotationplasty. This rotationplasty or Van Nes' so-called turn-about procedure is done for patients with severe deformity with the aim of levelling the ankle of the involved side with the knee of the uninvolved side [25]. It is a conversion of the knee to a hip joint by flexing it 90 degrees and fusing the femur to the pelvis and conversion of the foot into the knee joint, followed by fitting the short limb with a leg prosthesis [2,22].…”

Prosthesis for Unilateral Isolated Proximal Focal Femoral Deficiency: A Case Report and Review of the Literature

“…Prosthesis should be applied in all cases regardless of the ultimate treatment plan, whether surgical or nonsurgical, and the first management must contemporize with normal development. It serves as a "stopgap" as we wait for the baby to attain the age for surgical interventions or amidst the interval of surgical reconstruction [18]. Moreover, for an appropriately selected patient, no significant distinction with respect to physical function and quality of life was appreciable between prosthetics and lengthening [19].…”