Disclosures: Dana L. Sheng, MD: No financial relationships or conflicts of interest

Case Description: The twins have a complex medical history. Prior to separation, they were conjoined facing and leaning away from each other. They shared a single cloacal opening, one pelvis, and three legs, one of which was non-functional. Upon separation, each twin received a hemipelvis and one lower extremity, and they each required vesicostomy and colostomy. The twins have multiple orthopedic abnormalities, including kyphosis, scoliosis, hemivertebrae, and hemipelvis with absence of the contralateral lower extremity.

Setting: Specialty pediatric hospital

Patient: 5-year old formerly thoraco-omphalo-ischiopagus conjoined female twins Assessment/

Results: Navigating mobility for these twins required the use of a combination of rehabilitation techniques. The twins were separated at age 2, and once medically stable, spent 1 month in inpatient rehabilitation to improve their sitting balance and gross motor skills. This was followed by outpatient physical therapy twice a week. The twins initially had customized wheeled Bumbo seats, which they were able to wheel independently. After 6 months of therapy, the girls began walking with posterior walkers and a prosthesis. The hemipelvectomy prosthesis included a TLSO component customized to accommodate each twin’s vesicostomy and colostomy and was directly attached to a non-articulated pylon. A manual-locking hip joint was added to accommodate sitting. An articulated AFO was used for the intact leg. The twins ambulate modified-independent with their walkers and prosthesis and are now training with Lofstrand crutches.

Discussion: Thoraco-omphalo-ischiopagus conjoining of twins is a rare phenomenon and presents a unique challenge in rehabilitation and prosthesis/orthosis development.

Conclusion: Care of formerly conjoined twins is complex and requires comprehensive care from a multidisciplinary team involving, but not limited to, a physiatrist, orthopaedic surgeon, physical therapist, and orthotist/prosthetist.

Level of Evidence: Level IV

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/rehabilitation-of-formerly-conjoined-thoraco-omphalo-ischiopagus-twins-a-case-report/