Please help with this difficult trans-tibial case
wilder lafond
Description
Collection
Title:
Please help with this difficult trans-tibial case
Creator:
wilder lafond
Date:
10/12/2004
Text:
I'm soliciting suggestions for a case which has proved difficult.
The patient/client is a 48yr active K3 female who suffered a left 5.5inch trans-tibial amputation due to infection s/p crushing injury and subsequent surgeries. Her fibula is cut 1 distal to the head. There is significant non-muscular soft tissue posteriorly from the popliteal to the distal end, but no soft tissue extends beneath the cut end of the tibia. ~13 degrees genu varum exists bilaterally. She complains of significant daily volume fluctuation, but has not changed greater than 5-ply overall.
She currently wears an endoskeletal total surface bearing socket with 6mm Alpha Locking Liner, pin suspension & Freedom FS1000 energy storing foot. She also reports wearing a suspension sleeve to combat pistoning. However, she has asked us to avoid using a suspension sleeve in our design.
In her most recent socket, which appears to fit well, she complains of several painful areas and is unable to ambulate for moderate lengths of time. These areas include postero-laterally just superior to the popliteal trimline (and outside the socket, seems to be caused by tissue bunching), distal end of fibula, distal patella. Though her skin shows no sign of irritation, her complaints are consistent and do change appropriately with alignment changes, but are never resolved beyond tolerable.
We are currently considering:
Custom gel liner (Freedom, TEC etc)
Casting limb in distraction for elongation and soft tissue solidification
Using a clutch lock system to pull limb into lock rather than risk hamocking
High M-L trimlines for stability
Shock/torque absorber
We are continuing to fine tune our plan of action and would appreciate any product, modification or alignment tips from those who've experienced similar issues.
I'll post responses anonymously to the list serve unless otherwise requested.
Thank You,
Wilder LaFond
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The patient/client is a 48yr active K3 female who suffered a left 5.5inch trans-tibial amputation due to infection s/p crushing injury and subsequent surgeries. Her fibula is cut 1 distal to the head. There is significant non-muscular soft tissue posteriorly from the popliteal to the distal end, but no soft tissue extends beneath the cut end of the tibia. ~13 degrees genu varum exists bilaterally. She complains of significant daily volume fluctuation, but has not changed greater than 5-ply overall.
She currently wears an endoskeletal total surface bearing socket with 6mm Alpha Locking Liner, pin suspension & Freedom FS1000 energy storing foot. She also reports wearing a suspension sleeve to combat pistoning. However, she has asked us to avoid using a suspension sleeve in our design.
In her most recent socket, which appears to fit well, she complains of several painful areas and is unable to ambulate for moderate lengths of time. These areas include postero-laterally just superior to the popliteal trimline (and outside the socket, seems to be caused by tissue bunching), distal end of fibula, distal patella. Though her skin shows no sign of irritation, her complaints are consistent and do change appropriately with alignment changes, but are never resolved beyond tolerable.
We are currently considering:
Custom gel liner (Freedom, TEC etc)
Casting limb in distraction for elongation and soft tissue solidification
Using a clutch lock system to pull limb into lock rather than risk hamocking
High M-L trimlines for stability
Shock/torque absorber
We are continuing to fine tune our plan of action and would appreciate any product, modification or alignment tips from those who've experienced similar issues.
I'll post responses anonymously to the list serve unless otherwise requested.
Thank You,
Wilder LaFond
---------------------------------
Do you Yahoo!?
vote.yahoo.com - Register online to vote today!
********************
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 affiliations should be used in all communications.
Citation
wilder lafond, “Please help with this difficult trans-tibial case,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 1, 2024, https://library.drfop.org/items/show/223805.
