Responses-PFFD prosthesis

Responses-PFFD prosthesis

Mohammad Reza Mirheydari

1/14/2009

Dear list members
Great thanks to whom responded and helped .
I returned the patient to physician to order hip flexion contracture correction for her perior to making prosthesis .
Here follows original message with responses
 
-----Original Message-----

Dear list
Happy new year to you .
I have an one year old PFFD ( proximal focal femoral deficiency ) female
patient with about 11cm of R leg length discrepancy and hip flexion
contracture of about 90 degrees in right side that could passively be
corrected to 45 degrees manually .
The R femur has about 30% length of L femur , when standing upright on sound
leg the sole of R foot stands at level of L knee .
The knee in affected side also seems to have a bit flexion contracture ,
femoral head is smaller than sound side and isn,t located in the acetabulum
.
Physician has prescribed extension prosthesis for her and I like to make a
Moseley design device ( <URL Redacted> )for her .
The question is that should I manually correct hip flexion contracture when
casting ischial region or not ?
Your input is appriciated .
Sincerely & regards
Mohammad reza Mirheydari

 
I would say not to even start on a prosthesis yet. Try to reduce the hip
flexion contraction first. She is only a year old. Take a couple of months
and see what progress could be made. I see problems in stability of whatever
knee joints you use.AC Andrew A. Cinque CPO

I would suggest not to correct. It is likely that the correction is through the spine and thus correcting would increase lordotic curvature. Assuming that there is no active extention that would ever be functional with a prosthesis in the future, preserving the spinal alignment would be more beneficial than trying to correct a non-functional limb.
If however, I misread your presentation and the limb may become functional in the future to control a prosthetic device, you might assess all possible motor control (especially any active hip extention) and plan for future fittings. If the limb is totally non-functional, then preserve the spine and perhaps even wrap the limb into a hip disarticulation socket. Hoping for your good results, John Zeffer CP (E)

You can contact Mark Moseley in Los Angeles and ask him.
 
would make an ischial containment socket to control the frail hip rather than a lacer thigh corset. I think it is widely accepted that IC socket shapes give more stability to the gait and protect the hip joint. and correct flexion as much as possible with belts until the child is old enough to be properly manipilated and mobilised.
L Hughes P&O UK
 
The Mosely design will not stop the knee from buckling if there is a hip
flexion contracture present. The hip flexion has to be incorporated into the
design or corrected prior to fitting. A 90 degree contracture, even
manually corrected to 45 degrees, will cause the pt to fail the fitting
because the knee will buckle. Current limitations of hip flexion is 23
degrees corrected and there has to be a 5 degree addition to preflex the hip
extensors. The rotationplasty is not necessary, but the hip contracture
will have to be accommodated or surgically corrected (if possible).Additionally, pay attention to the natural progress of crawling and pulling
to stand. A program of active manipulation by a therapist to extend the hip
prior to the pulling to stand would maybe correct some of the hip flexion
prior to fitting at the pull to stand stage of development. Good luck Paul Oswald CPO
 
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