Prosthetics and Orthotics International

During the Plenary Session on Prosthetics and Orthotics in the Developing Countries the representatives of the United Nations and the World Health Organization expressed the personal views which follow. They are presented here to the membership at large in view of the widespread interest and the Society's involvement in the problems of improving service in the developing world.

A new water setting light plastic plaster material, ∗Crystona^R, is presented and its plaster room characteristics compared with plaster of Paris. Plaster of Paris is considered better as the “acute fracture splinting material” in the Accident Service setting. Crystona, however, has considerable advantages as the “dynamic bracing material” in the post-acute fracture period and is demonstrated in the functional bracing of femoral shaft fractures.

An improved functional cast brace design is presented, the “Knee Hinge Cylinder Brace” with a simple waist belt suspension to a hinged tube cast without the foot in the treatment of distal half femoral fractures. Using Crystona and the cylinder brace design, the cast weight has been reduced by half and the functional limb bracing improved with free mobilization of the knee, ankle and foot. The prescription, application technique and early clinical experiences are presented.

A new design, the ‘Hip Hinge Thigh Brace’ is presented for the safe early functional mobilization of patients with proximal half femoral shaft fractures. The mechanics, prescription, application technique and early clinical experience are reported. Use of the newer Crystona plastic plaster is shown to provide a more functional brace than the plaster of Paris casts.

Disarticulation between the proximal talus and calcaneous, and the distal navicular and cuboid (Chopart's disarticulation) was probably first performed in Britain by Syme in Edinburgh in 1829.

Although initially successful, it fell into disrepute because of equinus deformity that developed as a result of the unopposed action of the soleus-gastrocnemius muscles and tendoachilles on the os calcis. Callosities and corns developed on the anterior aspect of the skin flap. These could become rather painful and troublesome at times.

Nevertheless, it is an operation that is performed occasionally, and has a place in the range of conservative distal amputations of the lower limb. Whatever the views of the prosthetic team, they may be faced with a surgical “fait accompli” for which they have to provide a suitable prosthesis.

There are various prostheses available but we describe a prosthesis required to fulfil a cosmetic, functional and combined end-bearing and patellar-bearing need.

The self-aligning goniometer system of the Lamoreux type mounted on an exo-skeleton was applied ten times on the same normal person to measure hip and knee flexion and extension movements.

The standard deviation of full measurement was found to be approximately 5 per cent of the hip excursion and 10 per cent of the knee excursion. These figures were found throughout the test series as well as within each single test run.

The goniometer is considered a useful tool for clinical gait analysis.