prosthetic case presentations
TRANSCRIPT
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8/6/2019 Prosthetic Case Presentations
1/19
Prosthetic Case Presentation
Case #1
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8/6/2019 Prosthetic Case Presentations
2/19
Case presentation
PC; male 67 year old; sustained R trans
tibia amp, 1/2004 and L first metamputation secondary to diabetic infection.
Residual limb 4 to 5 length, normal
swelling, with the distal end one half inchlarger than proximal. Fit with trans tibia
prosthesis and was a householdambulator. Presented with approximately7 degree knee flexion contracture.
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8/6/2019 Prosthetic Case Presentations
3/19
Case presentation
Within the next six months had problems
with fluctuation in volume. His volumewould go up and down as much as two
inches. Wouldnt put the prosthesis on
first thing in the am, some days would notput it on at all, go to Reno sit in wheelchair
for a day or two.
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8/6/2019 Prosthetic Case Presentations
4/19
Case presentation
4/13/2005 had gained25 pounds and hisknee flexion
contracture hadincreased to 25degrees. Residuallimb increase in
circumferenceproximal to distal 3
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8/6/2019 Prosthetic Case Presentations
5/19
Case presentation
5/25/2006 increased issues with his LLE
and an open wound that was treated witha CROW boot. Healed later that year and
was cast for a custom shoe. Used aprosthesis without much success,encountering sores and wounds on the
residual limb. Inconsistent wear and non-compliance. Electric wheelchair bound
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8/6/2019 Prosthetic Case Presentations
6/19
Case presentation
Progressively wearing prosthesis less;
only as cosmetic in wheelchair
12/4/2008 at a follow-up visit; just didntfeel like putting it on.
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8/6/2019 Prosthetic Case Presentations
7/19
Case presentation
Current: thirty degree knee flexion
contracture on right, 20 on left and aboutthe same at the hip
Left side healed
Has edema in right residual limb, 1.5
larger distal.
Can get from sitting to standing fromwheelchair
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8/6/2019 Prosthetic Case Presentations
8/19
Case presentation
9/12/2009 Tells you hes now wanting to
walk again and will now follow instructions.
WHAT WOULD YOU DO?
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8/6/2019 Prosthetic Case Presentations
9/19
Case presentation
Be the prosthetic police and say sorry
Charlie you had your chance
Amputate at a higher level
Course of 2 months physical therapy toprepare for prosthesis
Fit with another trans tibia prosthesisOther
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8/6/2019 Prosthetic Case Presentations
10/19
Case presentation
Bent knee prosthesis
Weight bearing on abent knee.
Need approximately120 degrees of kneeflexion.
Initially no prostheticknee joint
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8/6/2019 Prosthetic Case Presentations
11/19
Case presentation
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8/6/2019 Prosthetic Case Presentations
12/19
Case presentation
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8/6/2019 Prosthetic Case Presentations
13/19
Case presentation
Case #2
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8/6/2019 Prosthetic Case Presentations
14/19
Case presentation
AG female 45 years old sustained Ltraumatic amputation from mopedaccident. Initially short trans tibia but not
closed. Comminuted closed proximalfemoral fracture same side. Other lifethreatening injuries and patient was in ICUfor two weeks. Patient was healthy 55
245lb. Office workerSurgeons want advice on amputation level
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8/6/2019 Prosthetic Case Presentations
15/19
Case presentation
Try to leave as a short trans tibia,
approximately at the tibia tubercle levelwith graft/scar tissue on the residual limb
Trans femoral amputation 3 inches abovethe knee
Knee disarticulation
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8/6/2019 Prosthetic Case Presentations
16/19
Case presentation
Surgeons were veryconcerned with theability to save any
residual limb withweight bearingsurface below theknee, and were
suspicious of infection
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8/6/2019 Prosthetic Case Presentations
17/19
Case presentation
Knee disarticulation toallow distal end weightbearing
Shortened the femur tokeep knee jointsanatomical
Avoided proximal ischialweight bearing
Better ability to controlprosthetic knee
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8/6/2019 Prosthetic Case Presentations
18/19
Case presentation
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8/6/2019 Prosthetic Case Presentations
19/19
Case presentation