part 2 longer fibula amputation

part 2 longer fibula amputation

Randall McFarland, CPO

Responses part 2

I have one patient like that. He happens to be aver 250lbs and does
perfectly fine in his prosthesis. I have him in an Alphaliner 6mm suction
socket that I got the impression the way TEC recommends with a suction pump
and I then global reduction. I also build in a patelly bar, (mild) and
pretibial depressions. However, his fib is not quite so long with respect to
his tib, maybe 3/4 inch. I would still treat her like a conical limb and gel
liner... maybe try tec urethane as it has the flow properties.
Sarah

We see many amputees with these kinds of unacceptable residuums that would
be hard to fit in many ways. Basically, pain, and the option of an open-end
socket are the factors between surgical revision. Many of our patients did
not get a good surgery with myodesis or myoplasty. Consequently there is not
a lot of tissue between the bony end and skin coverage. So if an open end
socket is not painful, we generally go with that. It is common here to use a
pull sock (hole in liner) to don the BK prosthesis. The issue of distal end
verucus hypoplasia is just beginning to take form and total contact sockets
are becoming more common at my center for good surgical results. Otherwise,
we send for surgical revision as there are no soft silicone liners etc.
available here.
Best regards,
John Zeffer
American Red Cross-Cambodia
Kompong Speu Rehabilitation Center

Since this was a recent amputation, I would venture to say that the surgeon
either had a very good reason or knows nothing about prosthetics! You can
pad the end with a good plastazoate distal end pad which is built up from
the tibia level to match the fibula protusion. If the difference is less
than 1/2 inch, you could try a Silipos silicone liner which has 9mm of soft
silicone on the distal pad. It shouldn't be to hard especially since your
offloading the distal end of the residual limb anyway in whatever design you
make.
Mike Kogan, CP

I had a patient with about a 1 difference in length between the Fib/Tib.
Was accomodated in the liner but still caused problems. You do this type of
amputatation well by calling it unconventional...I would call it a mistake.
Eventually we had Dr. Jan Ertl here at Kaiser do the Ertl proceedure. Have
not had any reports on his progress since surgury. My hopes are that he is
doing better.

Randy, she is probably looking at revision surgery in her future. What was
the
length of her limb and could the fibula be shorted and still have good length
for a transtibial fitting? Her small wt is in her favor. I would use a
custom
distal end pad of very soft silicone. You may even have to put light weight
joints and a thigh corset on her. Terry

Unfortunately, I have had nine experiences with fibular shafts longer than
the tibia. All from the same surgeon. Yours is the worst, as my guy
reversed Burgess' technique and precisely left the fibulas 3/4 longer.
    Throw away any thoughts of using pinned liners of any kind, as they are
too symetrical. I have success with liners with sleeves and valves, but you
must really concentrate on molding the distal end while casting to
differentiate the distal ends of the tibia and fibula. Your patient's two
inches will probabaly preclude even that, so I would retreat to a more
conventional Pelite or equal liner with 1/2 or better molded distal end pad.
  Again, careful molding so as to load the tibia and relieve the fibula with
plaster buildup prior to fabbing the insert. I have had success with them.
Regards,
Bill Schumann, CPO

I have a young patient (6yo) that has a similar situation due to traumatic
amputation. I used an alpha liner and show her how to squeeze her calf
area while donning the liner to push the tissue over the pointed fibula.
This worked for a long while. The surgeon want her to grow as much as
possible before limb revision to have more good skin tissue to wrap around
the limb where skin grafts are now.
   I used a locking liner with a fillaur shuttle lock. Needless to say this
patient is very active (trampoline, swimming, running, ballet) I know your
patient probably won't be doing these activities, but it does show it can
work under extreme circumstances
   If I can be of further help let me know glen waldner, cpo

This is sacrilegious - if the surgeon feels this is a definitive surgery -
it is malpractice or whatever term you want to use to describe it . I HAVE
FIT MANY WITH THIS CONDITION, ONLY ONE MAINTAINED IT TO THE DAY HE
PASSED-ON. All others had reconstruction/revision to correct. To either even
or slightly shorter.
    -Jan

                          ********************
To unsubscribe, send a message to: <Email Address Redacted> with
the words UNSUB OANDP-L in the body of the
message.

If you have a problem unsubscribing,or have other
questions, send e-mail to the moderator
Paul E. Prusakowski,CPO at <Email Address Redacted>

OANDP-L is a forum for the discussion of topics
related to Orthotics and Prosthetics.

Public commercial postings are forbidden. Responses to inquiries
should not be sent to the entire oandp-l list. Professional credentials
or affilliations should be used in all communications.