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case_images: Scoliosis radiographs of the twins post-separation reveal each twin had a hemipelvis.
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case_images: Upon separation, each twin had half a liver, half a gastrointestinal tract with an ileostomy or colostomy, a single kidney and ureter, a neobladder made from half of the shared bladder, a vesicostomy, and one intact hemipelvis connected to a lower extremity (Fig. 3).
case_images: The twins received ZipZac chairs that were customized by Shriners with flexible, custom-formed foam to support each twin's hemipelvis at midline as well as with parent push handles for use in the community. (Written photo consents obtained.).
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case_images: They were fitted for custom manual wheelchairs and were also given ZipZac chairs (Fig. 4) that they could transfer in and out of and self-propel around home and school.
case_images: The prosthetists made custom thoracolumbosacral orthoses for the twins. (Written photo consents obtained.).
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case_images: Each twin was measured for a custom thoracolumbosacral orthosis (TLSO) (Fig. 5), which could serve multiple purposes, mainly to provide a base of support for sitting and to act as the socket for their eventual ambulation with a prosthesis.
case_images: The custom thoracolumbosacral orthoses had attached marionette strings for aid with ambulation. (Written photo consents obtained.).
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case_images: Marionette strings were added (Fig. 6) to the proximal end of the prosthesis for therapists to assist with balance and weight bearing.
case_images: The hemipelvectomy prosthesis included a non-articulated pylon with a solid ankle cushion heel foot for a stable base of support. This was directly connected to the thoracolumbosacral orthosis.
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case_images: This was directly connected to the TLSO (Figs. 7, 8).
case_images: The custom thoracolumbosacral orthosis served multiple purposes, one of which was to provide a base of support for sitting.
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case_images: This was directly connected to the TLSO (Figs. 7, 8).
case_images: After several years with a walker, the twins progressed to using Lofstrand crutches. (Written photo consents obtained.)
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case_images: After several years with a walker, at about age five years and six months, the twins progressed to using Lofstrand crutches (Fig. 9) and multi-axial feet.
case_images: The twins now ambulate without an assistive device. (Written photo consents obtained.)
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case_images: Now, five years since separation, they are community ambulators, walking without the use of assistive devices (Fig. 10).