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The skin traction method, first described by Marquardt in the late 1960s, has been reported to be successful in selected cases. In many cases, the cause of pain is attributed to bone spurs and adventitious bursae, which can be treated with aspiration, steroid injections, and stump wrapping. Before wearing the prosthesis, soft tissues should be pulled distally to prevent “mushrooming” of the soft tissue proximally into the socket. The initial management of stump overgrowth includes prosthetic modifications and lifestyle adjustments. In the immature skeleton, the elastic characteristic of the periosteum allows it to pull away from the end of the amputee stump and leads to local bone formation, Figure 2. His study indicates that an amputation stump responds via wound healing and intramembranous bone formation. Speer, by conducting an experimental histological study on the immature skeleton of rabbits, described the pathogenesis of stump overgrowth and explained why it does not occur in the mature skeleton. If stump overgrowth is a local phenomenon, it is unclear why it is not observed following adult amputation. This explains why overgrowth does not occur in cases of disarticulation where there is intact articular cartilage rather than transected bone. Aitken implanted a radiographic marker in the bony stump and confirmed that overgrowth occurs distal to the marker, proving that overgrowth does not represent an epiphyseal contribution but rather a local phenomenon of bone healing. Studying the histology of stump overgrowth in rabbits, Hellstadius concluded that the medullary canal is the source of overgrowth. This would mean that overgrowth is a local process of bone formation and wound healing that occur in the distal stump.
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The incidence of the overgrowth phenomenon in cases of surgical and post-trauma amputations was higher compared with that of disarticulation amputation and congenital agenesis, which suggests that stump overgrowth might be a result of bone and soft tissue trauma rather than continuous growth of the proximal physis. observed bone growth stimulation following amputation and concluded that stump overgrowth occurs because soft tissues cannot keep up with the rapid growth of the bone however, attempts to treat overgrowth by proximal epiphysiodesis and leaving long redundant soft tissue have failed. Because overgrowth occurs in children, it has been suggested that overgrowth occurs as a result of disproportional growth between the remaining proximal physis and the contracted distal soft tissue and skin. Many hypotheses have been proposed to explain the phenomenon of bone overgrowth. Last, metaphyseal level amputations carry a higher risk of overgrowth than diaphyseal level amputations. An increased prevalence of overgrowth has been reported in patients who had previously undergone surgery for overgrowth. Aitke postulated that bone overgrowth in congenital cases is due to intrauterine amputation (amniotic band syndrome) rather than true agenesis, considering that bone overgrowth does not occur in congenital agenesis however, this assumption has not been proven. Traumatic amputations carry a higher risk of overgrowth than elective surgical amputations, as stump overgrowth is very rare in congenital agenesis but common in amniotic band syndrome. The most frequent locations are the humerus, followed by the fibula and the tibia, whereas stump overgrowth is rare in the radius and ulna. Younger patients have a higher incidence of stump overgrowth. Osseous overgrowth is not observed in children older than 12 years or in cases of disarticulation amputations.
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Among them age and location are the most influencing factors. Age, location, reason for amputation, and level of amputation are known factors that affect the prevalence of stump overgrowth. Stump overgrowth is the most common complication following limb amputation in children, and the incidence varies from 4 to 50%.