Prosthetic Case Presentations

8/6/2019 Prosthetic Case Presentations

1/19

Prosthetic Case Presentation

Case #1


2/19

Case presentation

PC; male 67 year old; sustained R trans

tibia amp, 1/2004 and L first metamputation secondary to diabetic infection.

Residual limb 4 to 5 length, normal

swelling, with the distal end one half inchlarger than proximal. Fit with trans tibia

prosthesis and was a householdambulator. Presented with approximately7 degree knee flexion contracture.


3/19

Case presentation

Within the next six months had problems

with fluctuation in volume. His volumewould go up and down as much as two

inches. Wouldnt put the prosthesis on

first thing in the am, some days would notput it on at all, go to Reno sit in wheelchair

for a day or two.


4/19

Case presentation

4/13/2005 had gained25 pounds and hisknee flexion

contracture hadincreased to 25degrees. Residuallimb increase in

circumferenceproximal to distal 3


5/19

Case presentation

5/25/2006 increased issues with his LLE

and an open wound that was treated witha CROW boot. Healed later that year and

was cast for a custom shoe. Used aprosthesis without much success,encountering sores and wounds on the

residual limb. Inconsistent wear and non-compliance. Electric wheelchair bound


6/19

Case presentation

Progressively wearing prosthesis less;

only as cosmetic in wheelchair

12/4/2008 at a follow-up visit; just didntfeel like putting it on.


7/19

Case presentation

Current: thirty degree knee flexion

contracture on right, 20 on left and aboutthe same at the hip

Left side healed

Has edema in right residual limb, 1.5

larger distal.

Can get from sitting to standing fromwheelchair


8/19

Case presentation

9/12/2009 Tells you hes now wanting to

walk again and will now follow instructions.

WHAT WOULD YOU DO?


9/19

Case presentation

Be the prosthetic police and say sorry

Charlie you had your chance

Amputate at a higher level

Course of 2 months physical therapy toprepare for prosthesis

Fit with another trans tibia prosthesisOther


10/19

Case presentation

Bent knee prosthesis

Weight bearing on abent knee.

Need approximately120 degrees of kneeflexion.

Initially no prostheticknee joint


11/19

Case presentation


12/19

Case presentation


13/19

Case presentation

Case #2


14/19

Case presentation

AG female 45 years old sustained Ltraumatic amputation from mopedaccident. Initially short trans tibia but not

closed. Comminuted closed proximalfemoral fracture same side. Other lifethreatening injuries and patient was in ICUfor two weeks. Patient was healthy 55

245lb. Office workerSurgeons want advice on amputation level


15/19

Case presentation

Try to leave as a short trans tibia,

approximately at the tibia tubercle levelwith graft/scar tissue on the residual limb

Trans femoral amputation 3 inches abovethe knee

Knee disarticulation

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16/19

Case presentation

Surgeons were veryconcerned with theability to save any

residual limb withweight bearingsurface below theknee, and were

suspicious of infection


17/19

Case presentation

Knee disarticulation toallow distal end weightbearing

Shortened the femur tokeep knee jointsanatomical

Avoided proximal ischialweight bearing

Better ability to controlprosthetic knee


18/19

Case presentation


19/19

Case presentation

Prosthetic Case Presentations

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