Bridging the gap: retrospective clinical casefiles analysis defines the key prosthetic provision challenges for children with a major lower limb absence in Cambodia

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Introduction Paediatric limb absence results in complex rehabilitation and requires distinct prosthetic care, yet literature on paediatric prosthetic provision remains sparse, hindering improvements in care.Methods 62 clinical casefiles of children with lower limb absence from prosthetic centres in Cambodia were analysed. Problems related to growth and prosthetic component failures were analysed across limb absence levels. Prosthetic repair and replacement rates were quantified for each component. Residual limb health conditions were reviewed and the impact of socket fit on these conditions was assessed.Results Growth posed the largest challenge, particularly for socket fit in knee disarticulation and transtibial cases. Durability issues were common for suspension systems and knees. Donated modular components were less durable than locally manufactured ones (foot: p < 0.001, knee: p = 0.008). Children with transtibial amputations reported more residual limb health issues (bone overgrowth: p = 0.002, wounds: p = 0.018, skin issues: p = 0.010). Poor socket fitting was associated with calluses (p = 0.007) and wounds (p = 0.005).Discussion The impact of growth on paediatric prosthetic provision has been quantified for children with different amputation levels. Findings provide insight to manufacturers of prosthetic components on durability considerations. Results provide clarity for care providers on the residual limb conditions to consider for children with different amputation levels and the impact of socket fit on these conditions.

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