Case study responses
Thomas Karolewski
Description
Collection
Title:
Case study responses
Creator:
Thomas Karolewski
Date:
6/27/2002
Text:
Thank you to all that responded to my inquiry regarding the case
study. The person who is actually faced with the situation is Dan
Tysver at Great Steps O&P in St. Cloud, Minnesota. I wanted to
include all the responses to the case study.
Original Post
The patient is 5'6 tall and weigh's 215 lbs. The surgeon chose to
amputate the skeleton at the hip disarticulation level, but.......
decided for unknown reasons to leave 8 of muscle tissue below the
ischium. Its all muscle and at the present time is solid tissue.
There is no femur inside. So, from a distance the the appearance of
the residual limb would be that of a mid thigh transfemoral amputee,
but in reality is a hip disarticulation.
This is all the information I know. I have no reason why the surgeon
left 8 of redundant tissue.
Any ideas for socket design that address ambulating and sitting?
What kind of components could attach to the socket design?
According to the student, a revision is not an option.
Responses:
#1 If you do not hear back from Tony van der Waarde drop him a
not at <Email Address Redacted>
He has fit an amputee like this with an IC suction socket. I have a
video tape of the fitting and of course am in Minnesota.
#2 Kevin Carroll offered some interesting perspectives on
fitting very short hip disartics as TF's.
Give him a call.
#3 Does the patient have muscle control over the remaining
tissue? I have heard cases of bk and ak patients with redundant
tissue at the distal end using the TEC Harmony system with good luck.
It seems that the vacuum solidifies the tissue to give good control.
Don't know if it would work on this case. My guess is that whoever
makes the prosthesis will try a few different ideas before they get
it right.
#4 I have had an identical case which I presented at the Northwest chapter
meeting many moons ago.
I treated the patient with an Ischial Containment Trans-femoral socket using
an Ossur Silicone suspension sleeve with reinforcement or matrix through the
total length of the residuum. The liner that I used is a clear with matrix
and it stabilized the soft tissue very well.
Swing-phase is initiated with pelvic tilting as in H/D prosthesis but much
more efficiently because of the longer lever arm. This patient has
been using the system for 8 years and still going strong.
#5 If you do not get any good luck on the list serve, you might
want to talk with Carlos Sambrano in CA for some advice. He has
taken on a certain specialty in hip disarticulations and has done
some of the best work I have seen. Being an educator at an ABC track
school. He studied under the German Maestro situation. Let his
knowledge, experience, and quality speak for itself.
#6 is it possible to use a silicon liner to stabilize the redundant
tissue? a lanyard could be used for donning as opposed to a pin. possibly a
modified ischial containment with a flexible lamination similar to a hip?
have you talked to otto bock? they have done some pretty wild set-ups in the
past.
#7 That much redundant tissue will take years to compress and
atrophy into a decent shape for socket fitting. Without a femur your
chances of
effectively controlling a hip jointed prosthesis with the loose tissue
aren't great, either. This client should consider some type of revision
surgery if they hope to use a prosthesis right away.
#8 If the thigh tissues are movable how about bringing them anteriorly and
laterally. This would appear as a bump on the front of a HD socket and
should allow room for the hip joint to be mounted in a standard way.
#9 Consider a suction suspension insert (full length matrix to prevent
elongation - Iceross transfemoral) with locking pin, flexible wall
socket/rigid frame. If the tissue is indeed solid, it should not be too
difficult to don the insert. If the tissue is not solid, this probably
will not work. A pelvic joint, band and belt could be used to control
rotation.
#10 I would first try a hybrid socket incorporating a canadian
style hip dis. prosthesis, with encapsulating the redundant tissue
similar to an AK style.
If the redundant muscle flap has any tone, connect from the distal end to the
knee joint with a modular system. The muscle flap with tone should help
forward progression. As for sitting you will have to design a swivel on th e
lateral aspect. Tissue containment will be the obstacle here. In my
experience in creative prosthetics, all is out the window, sometimes you have
to think outside the field standards
#11 Was this surgeon thinking he'd try to put an artificial hip in there or
something and then realized it wouldn't work??? What a mess...! That is
going to be so unstable, I'd wonder about going back for revision or going
without a prosthesis altogether. Will be very interested to see any
possible solutions. Well, what about basically a hip disartic design but
hinging it to a Sabolich-style frame around the socket for it, for
connection back to the pylon above the knee- might that be rigid enough,
or could stronger materials than usual be used?
#12 Unbelievably but I had the same exact thing happen about seven years
ago! It looked like an elephant trunk. That surgeon was trying to save the
patient's life following a car wreck and just didn't want to mess with a
pulverized femur but remembered to save as much as possible. I sent him
back for a revision to remove all that useless musculature.
--
Thomas Karolewski, C.P.,FAAOP
Assistant Director of Prosthetics Education
Northwestern University Prosthetics- Orthotics Center
1(312)238-1182
********************
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OANDP-L is a forum for the discussion of topics
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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.
study. The person who is actually faced with the situation is Dan
Tysver at Great Steps O&P in St. Cloud, Minnesota. I wanted to
include all the responses to the case study.
Original Post
The patient is 5'6 tall and weigh's 215 lbs. The surgeon chose to
amputate the skeleton at the hip disarticulation level, but.......
decided for unknown reasons to leave 8 of muscle tissue below the
ischium. Its all muscle and at the present time is solid tissue.
There is no femur inside. So, from a distance the the appearance of
the residual limb would be that of a mid thigh transfemoral amputee,
but in reality is a hip disarticulation.
This is all the information I know. I have no reason why the surgeon
left 8 of redundant tissue.
Any ideas for socket design that address ambulating and sitting?
What kind of components could attach to the socket design?
According to the student, a revision is not an option.
Responses:
#1 If you do not hear back from Tony van der Waarde drop him a
not at <Email Address Redacted>
He has fit an amputee like this with an IC suction socket. I have a
video tape of the fitting and of course am in Minnesota.
#2 Kevin Carroll offered some interesting perspectives on
fitting very short hip disartics as TF's.
Give him a call.
#3 Does the patient have muscle control over the remaining
tissue? I have heard cases of bk and ak patients with redundant
tissue at the distal end using the TEC Harmony system with good luck.
It seems that the vacuum solidifies the tissue to give good control.
Don't know if it would work on this case. My guess is that whoever
makes the prosthesis will try a few different ideas before they get
it right.
#4 I have had an identical case which I presented at the Northwest chapter
meeting many moons ago.
I treated the patient with an Ischial Containment Trans-femoral socket using
an Ossur Silicone suspension sleeve with reinforcement or matrix through the
total length of the residuum. The liner that I used is a clear with matrix
and it stabilized the soft tissue very well.
Swing-phase is initiated with pelvic tilting as in H/D prosthesis but much
more efficiently because of the longer lever arm. This patient has
been using the system for 8 years and still going strong.
#5 If you do not get any good luck on the list serve, you might
want to talk with Carlos Sambrano in CA for some advice. He has
taken on a certain specialty in hip disarticulations and has done
some of the best work I have seen. Being an educator at an ABC track
school. He studied under the German Maestro situation. Let his
knowledge, experience, and quality speak for itself.
#6 is it possible to use a silicon liner to stabilize the redundant
tissue? a lanyard could be used for donning as opposed to a pin. possibly a
modified ischial containment with a flexible lamination similar to a hip?
have you talked to otto bock? they have done some pretty wild set-ups in the
past.
#7 That much redundant tissue will take years to compress and
atrophy into a decent shape for socket fitting. Without a femur your
chances of
effectively controlling a hip jointed prosthesis with the loose tissue
aren't great, either. This client should consider some type of revision
surgery if they hope to use a prosthesis right away.
#8 If the thigh tissues are movable how about bringing them anteriorly and
laterally. This would appear as a bump on the front of a HD socket and
should allow room for the hip joint to be mounted in a standard way.
#9 Consider a suction suspension insert (full length matrix to prevent
elongation - Iceross transfemoral) with locking pin, flexible wall
socket/rigid frame. If the tissue is indeed solid, it should not be too
difficult to don the insert. If the tissue is not solid, this probably
will not work. A pelvic joint, band and belt could be used to control
rotation.
#10 I would first try a hybrid socket incorporating a canadian
style hip dis. prosthesis, with encapsulating the redundant tissue
similar to an AK style.
If the redundant muscle flap has any tone, connect from the distal end to the
knee joint with a modular system. The muscle flap with tone should help
forward progression. As for sitting you will have to design a swivel on th e
lateral aspect. Tissue containment will be the obstacle here. In my
experience in creative prosthetics, all is out the window, sometimes you have
to think outside the field standards
#11 Was this surgeon thinking he'd try to put an artificial hip in there or
something and then realized it wouldn't work??? What a mess...! That is
going to be so unstable, I'd wonder about going back for revision or going
without a prosthesis altogether. Will be very interested to see any
possible solutions. Well, what about basically a hip disartic design but
hinging it to a Sabolich-style frame around the socket for it, for
connection back to the pylon above the knee- might that be rigid enough,
or could stronger materials than usual be used?
#12 Unbelievably but I had the same exact thing happen about seven years
ago! It looked like an elephant trunk. That surgeon was trying to save the
patient's life following a car wreck and just didn't want to mess with a
pulverized femur but remembered to save as much as possible. I sent him
back for a revision to remove all that useless musculature.
--
Thomas Karolewski, C.P.,FAAOP
Assistant Director of Prosthetics Education
Northwestern University Prosthetics- Orthotics Center
1(312)238-1182
********************
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.
Citation
Thomas Karolewski, “Case study responses,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 5, 2024, https://library.drfop.org/items/show/219011.
