Response to "Very Short Transfemoral/Shoulder Disarticulation"

Response to "Very Short Transfemoral/Shoulder Disarticulation"

Eric Schwelke, C.P.O.

10/15/1999

Here are the responses so far from our original posting:
To all:
We are evaluating a new referral w/ the following Hx:
36 yo female s/p traumatic (suicide attempt) Rt. Transfemoral and Rt.
Shoulder Disarticulation. We are only considering lower extremity now. We
have requested films to get a better idea of bone length, but it appears to
be only 1-2 inches. Almost entire aspect of residuum is grafted in a
patchquilt; very lumpy and firm but in good condition. Grafts go as high as
iliac crest. ROM is WNL, and muscle power is good all around. Physically,
there are no other problems. Referral is in a rehab setting, completely
independent, ambulates (hops) with a walker with center handle for 100'-150'
and is highly motivated at this point in time. We are leaning towards
treating as a hip dis, as we don't see how a transfemoral socket can be
functional.
Any ideas, suggestions, or comments on casting techniques, socket design,
and hip/knee components would be greatly appreciated. Replies will be
posted back on the server for all interested.
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Yeah, I would probably think in terms of a hip disartic. also. It really
depends on the contour, and skin integrity (mostly grafts as you say) of the
residual limb).
Obviously any sensory, or biomechanical advantages you want to keep.
If the grafts are not full thickness, and are not mobile I would probably us
a custom gel liner, like a TEC, or your own fabrication area of choice.
In regards to the socket, you might look at the Littig hip components.
Also Littig uses a split flexible ethylene bridge on a hip disartic. I saw
of
his once, and this seems like it would offer more volitional liberty with
the
residual motion of the hip & Femoral residual limb.
Good Luck...also make sure you know who is treating her mental realities and
what medications she is on. This is very important so that when the both of
you go forward toward an ambulation goal, that you see the same skies as
much
as possible.
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Only one response so far. Anyone else out there with ideas, experiences,
suggestions??

Thanks,

Eric Schwelke, C.P.O.