Prosthetics and Orthotics International

This retrospective study was designed for the period 1982 – 2002 to collect the basic data on the demography, level and side of the amputation, involved limbs, age, gender, and prosthetic functional level in children with limb loss. A total of 232 children were assessed through their prosthetic records. Seventy-two percent (195 children) presented lower-limb involvement, and 28% (77 children) had upper-limb loss. The age of the children varied between 1 and 15 years with a mean age of 9.90 ± 2.32 years. Results of the study revealed that the leading amputation cause in children was congenital limb absence. The most frequent levels were determined as trans-tibial and trans-radial in lower and upper limbs, respectively. Findings showed that more boys (60%) were affected, and 84% of all amputations were found to be unilateral. It was also seen that right-side amputations (54%) were more common than left-side amputations (46%). The outcome of the study showed that 96% of children with lower-limb loss reached a functional gait pattern without any aids, while the percentage of independence in activities of daily living was found to be 88% in upper-limb loss.

Standing up is an important and common daily activity. It is essential for independence and a prerequisite for walking. Many elderly and many subjects with impairments have problems with transition from sitting to standing. The aim of the present study was to determine whether there was any difference between the characteristics of standing up in trans-femoral amputees and healthy subjects. Five young trans-femoral amputees and five healthy subjects were included in the study. They were asked to stand up. The body motion was recorded using an Optotrak contactless optical system. The force and moment vectors exerted on the seat were recorded by a JR3 six-axis robot wrist sensor. The force under the feet was recorded by two AMTI force plates. The trans-femoral amputees were found to stand up more slowly than the healthy subjects. The angles of the hip, knee, and ankle joints on the amputated side were different from the angles on the healthy side or in the healthy subjects. There was also a great difference in loading between the healthy and the prosthetic foot. It can be concluded that there are differences in standing up between the trans-femoral amputees and the healthy subjects. These differences may indicate a reason for problems many elderly trans-femoral amputees face when standing up.

This is the first study to report on hip range of motion (ROM) among active prosthesis users, when wearing and not wearing a trans-femoral socket prosthesis and to compare with individuals rehabilitated with an osseointegrated bone-anchored prosthesis. In addition, discomfort when sitting with the prosthesis is reported in both groups. The study group all had a non-vascular amputation and were divided into those supplied with a socket prosthesis (S group) (n = 43, mean age 51 years, 74% men) or a bone-anchored prosthesis (OI group) (n = 20, mean age 46 years, 75% men). Active hip ROM was measured with a goniometer, and self-reported problems with discomfort when sitting were recorded. The hip motion decreased in all directions when wearing the socket prosthesis compared to without it (P < 0.001 for all directions), and 37% of the subjects had less than 90° of hip flexion when wearing their prosthesis. Discomfort when sitting was reported among 44% (n = 19) in the S group and was more common among individuals with less than 90° of hip flexion motion (P = 0.025). In the OI group, no restriction in hip motion was measured with the prosthesis, and no subject had less than 90° of flexion and 5% (n = 1) reported discomfort when sitting. This study shows that a trans-femoral prosthetic socket significantly reduces the ROM of the hip and that discomfort when sitting is common among individuals wearing such prostheses. Further, the study confirms that individuals using a bone-anchored prosthesis have no restricted hip motion with the prosthesis and report very few problems with discomfort when sitting.

A sand-casting technique for trans-tibial sockets was applied to 28 amputees, and the prosthetic fit observed through transparent check sockets. The results were better than historical reports of fittings with plaster of Paris casting by qualified prosthetists. The fit was consistently and evenly larger than the stump, but total contact could be achieved by applying three (two to five) stump socks. This would normally be considered on the high side of a good fit.

The Canadian prosthesis is indicated for the more proximal levels of amputation of the lower limb (very short trans-femoral, hip disarticulation and hemipelvectomy cases); it is frequently rejected by many patients for different reasons (awkwardness, intolerance of the socket, excessive energy expenditure to ambulate among others). The objective was to analyse the use or rejection of Canadian prostheses (n = 23) after an 8-year follow-up study (range: 2 – 16 years). The sample consisted of 52% men and 48% women, and the average age at the time of amputation was 52.26 ± 19.71 SD years (range: 1 – 74 years). The most frequent aetiology was malignant tumour (56.5%). Eight of the subjects continued to use the prosthesis through the entire study (34.7%). Gender, age, and aetiology were not significant determinants of use. The daily use was 12.5 h per day. The rejection of the Canadian prosthesis was after 20 months of use (range: 2 – 48 months), and the main reasons were death (all tumour causes), intolerance to the socket, or difficulty in ambulation. In conclusion, many years after their discharge from rehabilitation services, more than one-third of the sample (34.7%) were wearers of the Canadian prosthesis.

The paper deals with the identification of motor strategies adopted by trans-femoral amputees to compensate for the constraints of hip motion induced by the interference of the socket with the pelvis and, particularly, with the ischial tuberosity. A group of 11 subjects with trans-femoral amputation, three of whom wore two different prostheses, giving a sample size of 14 cases, were studied by gait-analysis protocols: the present paper focuses on the pelvis – thigh kinematics at foot strike. The results showed that, at the prosthetic side, the hip is significantly less flexed and less extended, respectively, at the ipsilateral and contralateral foot strike. Moreover, the pelvis is significantly more anterior tilted at sound foot strike. The anterior step length showed a decreased sound limb anterior step in 12 out of 14 cases. The authors interpret these results as a combination of mechanical constraints and compensatory actions: the reduced prosthetic hip extension is determined by the mechanical constraint involved in the pelvis – socket interference; and the increased pelvis tilt and sound hip flexion occurring at the same time are compensating strategies, adopted by the amputees, in order to obtain a functional step length and symmetrical thigh inclinations. Those factors determine a gait pattern which is functional, only slightly slower than normal gait, and without any perceivable alterations. On the other hand, the authors show that the increased pelvis tilting necessarily overloads the lumbar tract of the spine and may be related to the frequent occurrence of low-back pain in amputee subjects, despite the positive functional gait recovery.

This study compares a standard soft dressing (SSD) with a removable rigid dressing (RRD) in a randomized, controlled trial using 50 dysvascular trans-tibial amputees. Both dressing types were applied immediately post-operatively and were only removed for wound dressing changes. Half the subjects were allocated prospectively by ballot to either the RRD group or the SSD group. There was a strong trend indicating that primary wound healing of the stump occurred almost 2 weeks earlier in subjects using the RRD (RRD = 51.2 days ± 19.4; SSD = 64.7 days ± 29.5; P = 0.07; RRD: n = 17; SSD: n = 14.) There were no significant differences between the other parameters measured which included time to prosthetic fitting, length of hospital stay, incidence of stump breakdown, and time taken for stump volume to stabilize. The incidence of stump damage due to falls was also recorded, the results indicating that RRDs may protect the new stump from trauma.