Prosthetic Case Presentation

Case #1

Case presentation
PC; male 67 year old; sustained R trans tibia amp, 1/2004 and L first met amputation secondary to diabetic infection. Residual limb 4 to 5 length, normal swelling, with the distal end one half inch larger than proximal. Fit with trans tibia prosthesis and was a household ambulator. Presented with approximately 7 degree knee flexion contracture.

Case presentation
Within the next six months had problems with fluctuation in volume. His volume would go up and down as much as two inches. Wouldnt put the prosthesis on first thing in the am, some days would not put it on at all, go to Reno sit in wheelchair for a day or two.

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4/13/2005 had gained 25 pounds and his knee flexion contracture had increased to 25 degrees. Residual limb increase in circumference proximal to distal 3

Case presentation
5/25/2006 increased issues with his LLE and an open wound that was treated with a CROW boot. Healed later that year and was cast for a custom shoe. Used a prosthesis without much success, encountering sores and wounds on the residual limb. Inconsistent wear and noncompliance. Electric wheelchair bound

Case presentation
Progressively wearing prosthesis less; only as cosmetic in wheelchair 12/4/2008 at a follow-up visit; just didnt feel like putting it on.

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Current: thirty degree knee flexion contracture on right, 20 on left and about the same at the hip Left side healed Has edema in right residual limb, 1.5 larger distal. Can get from sitting to standing from wheelchair

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9/12/2009 Tells you hes now wanting to walk again and will now follow instructions. WHAT WOULD YOU DO?

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Be the prosthetic police and say sorry Charlie you had your chance Amputate at a higher level Course of 2 months physical therapy to prepare for prosthesis Fit with another trans tibia prosthesis Other

Case presentation
Bent knee prosthesis Weight bearing on a bent knee. Need approximately 120 degrees of knee flexion. Initially no prosthetic knee joint

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Case #2

Case presentation
AG female 45 years old sustained L traumatic amputation from moped accident. Initially short trans tibia but not closed. Comminuted closed proximal femoral fracture same side. Other life threatening injuries and patient was in ICU for two weeks. Patient was healthy 55 245lb. Office worker Surgeons want advice on amputation level

Case presentation
Try to leave as a short trans tibia, approximately at the tibia tubercle level with graft/scar tissue on the residual limb Trans femoral amputation 3 inches above the knee Knee disarticulation ??????????????????????????????

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Surgeons were very concerned with the ability to save any residual limb with weight bearing surface below the knee, and were suspicious of infection

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Knee disarticulation to allow distal end weight bearing Shortened the femur to keep knee joints anatomical Avoided proximal ischial weight bearing Better ability to control prosthetic knee

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