21 Apr 2011
By: JOAN CHEW
Life dealt a cruel blow to teenager Jenny Tan (not her real name) last October. The 17-year-old was riding pillion on her boyfriend's motorcycle one night when a taxi rammed into their vehicle and flung her onto the road.
While her boyfriend escaped with minor injuries, she had to have her right leg amputated above the knee.
Like her, another young girl's life was turned topsy-turvy on April 3 when she fell onto the tracks at the Ang Mo Kio MRT station.
Thai teenager, Peneakchanasak Nitcharee, 14, lost both her legs – one was severed when the train hit her and the other was so badly mangled it had to be amputated in hospital.
Fortunately, young amputees like these two teens are few and far between, doctors say.
Amputations are more likely because of diabetes or peripheral vascular disease, which are illnesses that hit people when they are older. Children require amputations normally because of accidents, advanced cancers or congenital conditions.
Dr Kevin Lim, senior consultant orthopaedic surgeon and deputy chairman of the division of surgery at KK Women's and Children's Hospital, said he has seen only two children who needed lower limb amputations in the last five years.
Associate Professor James Hui, head and senior consultant at the division of paediatric orthopaedics at National University Hospital (NUH), said fewer childhood amputations are needed now when compared with a decade ago.
Surgeons are now able to reconstruct deformed limbs arising from congenital conditions, instead of amputating and fitting them with prostheses.
For young accident victims, losing limbs is a traumatic shock.
However, if they can overcome that, physically, they have an edge over elderly diabetic patients.
Young versus old amputees
They are fit and usually have no existing medical conditions, so they stand a very high chance of being able to walk again if they are fitted with a prosthetic limb.
Young patients also learn how to use artificial limbs and adapt to them much more quickly than older patients.
Often, they can develop a reasonably normal gait, or walking pattern, over a shorter period of time, which is a boost to their self-esteem.
Associate Professor Joseph Thambiah, head and senior consultant at the division of orthopaedic trauma at NUH, said: "They may walk with a slight limp which is perceptible to a trained eye, but a normal person observing will not be able to detect that he or she is wearing a prosthesis."
Nor do young trauma patients face issues like poor blood circulation leading to infections and poor wound healing, he said.
This is often the case for diabetics, whose impaired blood circulation can lead to the breakdown of skin and tissue in the stump.
Prof Thambiah said: "If circulation to the residual limb or stump is compromised, surgeons may decide to amputate at a higher level."
With a prosthesis, the stump takes on more stress as it becomes weight-bearing, so proper blood circulation to this part of the body is important, he added.
Prostheses require more energy
Wearing a prosthesis does not equate to being able to walk in one, doctors say. Amputees have to use more energy to manoeuvre an artificial limb.
Associate Professor Low Yin Peng, an emeritus consultant at the department of orthopaedic surgery at Tan Tock Seng Hospital (TTSH), said that a patient with a single leg amputation below the knee uses 40 per cent more energy to walk with a prosthesis than an able-bodied person using his natural legs.
If the amputation was done above the knee, he or she would use up to 80 per cent more energy, he added.
Faced with such a challenging feat, it is no wonder that Associate Professor Inderjeet Singh Rikhraj, senior consultant at the department of orthopaedic surgery at Singapore General Hospital (SGH), has not seen any of his elderly, diabetic patients with an above-knee amputation walk again even with a prosthesis.
He said: "It's a fact that a single above-knee amputee uses more energy to walk than a person who has both his legs amputated below the knees."
Of the 40 patients who undergo amputations at SGH every year – the majority of them diabetic – 80 per cent would stay in a wheelchair for the rest of their lives, he added.
Often, surgeons try to do an amputation as distal, or far down, as possible, to "reduce the amount of disability that a patient will have", said Prof Thambiah.
Kids adapt even faster
With or without a prosthesis, young patients seldom have any issue adapting to their shortened limbs, said NUH's Prof Hui.
Since the child has used his missing limb for a shorter period of time than an adult, it is easier for him to live without it.
Prof Hui has seen child amputees pick up objects easily with one functional hand and a stump.
Others would rather do without a prosthesis and chase after a ball with a leg and a crutch.
But since they are constantly growing, their prostheses have to be changed annually, which means they have to spend more on these aids in the long run than adult amputees.
An adult would need a change every two or three years due to wear and tear, said Prof Low.
Learning to walk again
Jenny was hospitalised for 10 days after the accident.
Since last December, she has had weekly physiotherapy at SGH to stretch and strengthen the muscles of her residual leg and build upper body strength.
She is now waiting to be fitted with a prosthesis at TTSH's Foot Care and Limb Design Centre.
For now, she gets around on crutches or in a wheelchair, she said. Mostly, she stays home watching television or using the computer.
She has come to terms with her condition after being counselled by SGH nurses and receiving visits from amputees like stockbroker Lieu Teck Hua, 30 (see story on page 12).
Jenny has tried using a prosthesis with the help of support from parallel bars in the hospital but admits finding it difficult.
At times, she wants to give up and stay in the wheelchair for good.
But seeing a fellow amputee like Mr Lieu get his life back, Jenny believes she can do likewise.
She said: "I still have both hands and a leg, so I can be like a normal person."
Email: joanchew@sph.com.sg
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