prosthetic and surgical suggestions requested: unstable TR amputation - mobile radius

prosthetic and surgical suggestions requested: unstable TR amputation - mobile radius

James Little

3/16/2010

Dear Colleagues,

I would appreciate your input and experience to assist a new TransRadial
patient who has a subluxed radial head and consequently limited elbow ROM.

This young gentleman had a MVA which resulted in the amputation of his
forearm at the mid radius level. The interosseous membrane was badly damaged
(shredded according to his surgeon) and consequently the radius is
unstable and mobile proximally. The ulna remains well attached at the
humerus. The radius has subluxed proximally and anteriorly such that it
impacts the humerus, limiting flexion to about twenty degrees.

The surgeon has put forward a few surgical possibilities (remove radial
head, remove radius entirely ....) to improve flexion range and has asked
for feedback regarding the functional outcomes with a prosthesis for each
procedure. We have also discussed prosthetic accommodations (step-up hinges,
pre flexed forearm section ...) in the event that no further surgery is
undertaken. We do not currently believe that standard prosthetic
interventions for limited elbow ROM will be sufficient for this gentleman as
he has a young family and lives in a rural area. The rehab team is leaning
toward surgical. Has anyone had experience with a bone bridge for TR
amputation to stabilize the radius and ulna in the absence of a functional
interosseous membrane?

Please provide feedback if you have had similar experiences or if you can
suggest a surgical and/or prosthetic intervention that may be more
appropriate.


Thank you,


--
W. James Little, B.Sc., C.P.(c)
Vancouver Island Prosthetic Services Inc.
26-1708 Bowen Rd.
Nanaimo, BC V9S 1G9
(250) 713-5272
Fax (250) 753-0316