Prosthetics and Orthotics International

Ten (10) diabetic and 7 nondiabetic patients on renal replacement therapy have undergone limb amputation in the authors’ unit in the 1988 to 1996 period. The article examines the course of illness and survival patterns in this distinct and increasing subset in the amputee population. Rehabilitation and survival were significantly better in the diabetic group and it is recommended that it would be helpful for both prognosis and analysis if the subset of amputees on treatment for chronic renal failure is further divided into diabetic and nondiabetic subsets.

Information on the characteristics of children with limb deficiencies and amputations in the Netherlands is largely lacking. The present study aimed to collect data about the prevalence of congenital deficiencies, the ratio of congenital to acquired limb deficiencies, types of lower leg deficiency or amputation and male/female ratios.

Data were obtained from a regional birth defects registry for the northern part of the Netherlands (EUROCATNNL) and from a national survey. Inclusion criteria for the selection of the EUROCAT data were: children/foetuses with lower leg deficiencies born in 1981–1986. Inclusion criteria for the survey data were: children aged 1–18 years with congenital deficiencies or acquired amputations of the leg, excluding toe deficiencies/amputations.

Both the regional birth defects registry and the national survey only yielded small numbers of children, which limits the validity of the authors’ findings. The Eurocat data show a prevalence of lower leg deficiencies at birth Of 2.07/10,000. Fiftyfive (55) children/foetuses were included in the present study. The male/female ratio was 1:1. Of the liveborn children, 30% also had defects of the upper limbs, while 38% had bilateral lower limb deficiencies. The national survey included 89 children, of whom 73% had congenital deficiencies, while the others had undergone amputations: of which 37% were due to malignancies, 29% to traumata, 13% to infections and 21% to other pathology. The male/female ratio was 7:3 for the children with congenital deficiencies, versus 6:4 for the children with acquired amputations. In the group of congenital deficiencies, fibula deficiency was most frequently seen (36%), while in the group with acquired amputations transfemoral amputation, knee disarticulation and transtibial amputation were seen with equal frequency (21%). In 40% of the children with congenital deficiency and in 8% of the children with acquired amputations the arm was also affected. Both legs were affected in 37% of the children with congenital deficiencies and in 8% of the children with acquired amputations.

The aim of the study was to evaluate the use of prostheses, some secondary complications and functional aspects among children who had a congenital leg deficiency or an acquired leg amputation.

Rehabilitation physicians were asked to refer children, aged 1–18 years, with a leg deficiency or amputation. Mentally retarded children, children who had only had a toe amputated and children within one year after amputation were excluded.

A total of 88 children were included; 64 with a congenital deficiency and 24 with an acquired amputation. In 25 of these 88, both legs were affected; 28 children also had an arm deficiency or amputation.

A structured interview was held and the ChildHAQ assessed. Five (5) questions from the ChildHAQ, all relating to leg functions, were analysed.

All but 7 children had had a prosthesis fitted, most (89%) using it for almost the entire day. In the children with congenital deficiencies, the first prosthesis had been fitted at an average age of approximately 18 months. Four (4) of the 7 children without prostheses used orthopaedic footwear. The 10 children with congenital deficiencies necessitating prostheses with articulated knees had the first knee of this type fitted at an average age of approximately 37 months.

Fortyseven (47) of the 88 children had needed one or more (secondary) operations. In the children with congenital deficiencies, this was usually a conversion procedure, while the children with an acquired amputation had usually been operated on for osseous overgrowth. Twenty (20) of the 88 children experienced or had previously experienced phantom sensations, 5 children phantom pain. Skin problems were common.

Most children (95%) were able to walk, most of them (93%) more than 100m and 93% of the children aged 4 years or over were able to cycle. Most children (94%) aged 6 years or over were able to don and doff their prostheses independently. Some 90% of the children aged 4 years or over attended a normal primary or secondary school. Most (93%) of the children were able to take part in the physical education programme at school, although frequently (47%) with some degree of difficulty.

The functional abilities of 88 Dutch children with congenital leg deficiencies or leg amputations were found to be generally satisfactory. Most of the children used prostheses in their daily activities. Secondary complications were, however, frequent.

There is little published material in recent years about the use of lower limb prostheses in an elderly amputee population. In this study the authors were interested in the technical changes to lower limb prostheses after a first limb fitting procedure in a postrehabilitation population in the Netherlands.

The process of fitting a prosthesis and the technical changes to the artificial limb in the first year afterwards are studied.

The most popular early walking aid (EWA) in the United Kingdom (UK) is the Pneumatic PostAmputation Mobility aid or PPAM aid. A disadvantage of this device is that it does not allow a transtibial amputee to flex or extend the knee during walking. The Amputee Mobility Aid (AMA) was developed to allow knee movement, enabling transtibial amputees to practise a more natural gait. The benefits of using EWAs include early walking, reduction in postoperative oedema and improvement in patient morale.

This pilot study investigated the pneumatic bag/stump interface pressures of the PPAM aid and the AMA. In addition, the range of motion of the knee on the amputated side and the mechanical knee of the AMA were compared.

The AMA was found to have higher interface pressures than the PPAM aid during standing and similar pressures during supported walking. Subjects using the AMA did flex and extend their knee during walking but through a reduced range of motion. There were no significant differences between the angular movements of the AMA's mechanical knee and the patient's knee within it.

Thirtytwo (32) trained prosthesis users with 34 transtibial amputations, mostly due to war, were fitted with prostheses fabricated from polypropylene (PP) prosthetic components designed and manufactured by the International Committee of the Red Cross (ICRC). The patients were followed prospectively for 10 and 19 months. All but one patient had at least one other type of prosthesis to compare with.

Twentyeight (28) patients were satisfied with the PP prosthesis. Among these 23 found the PP prosthesis the preferred artificial limb, and one patient found the PP limb equal to the aluminium prosthesis previously in use. In 6/28 patients having an aluminium (ALU) prostheses this was found the best, and the 1 already mentioned found it equivalent to the new technology. In only 1/20 cases having an Automated Fabrication of Mobility Aids (AFMA) prosthesis available this was found the best. One (1) doubleamputee found all three designs equal.

Minor failures of the PP prostheses were encountered; in 4 cases small cracks in the hard socket; in 3 cases cracks of the cosmetic socket seam. From an overall prospect the PP technology can be recommended for transtibial prostheses.

During gait the motion of the residual femur within a transfemoral socket may be estimated using video recorded data from two ultrasound transducers attached to the socket wall. This paper reviews possible measurement errors and identifies the magnitude of the inaccuracies. Inaccuracies due to equipment limitations and those due to human error are identified and quantified. Ranges of flexion/extension and abduction/adduction of the residual femur within the socket during gait have been estimated with a cumulative level of inaccuracy of <1°.

The concept of measuring pressure at the interface between the stump and the prosthetic socket could provide valuable information in the process of prosthetic socket fabrication, modification, and fit. Two systems, the Rincoe Socket Fitting System (SFS) and Tekscan's FSocket Pressure Measurement System, have been commercially designed for in situ interface pressure measurement over the past decade. Their use is not common in prosthetic practice, perhaps due to questions of cost effectiveness and the difficulties of interpreting the data. Another concern is the use of sensors for pressure measurements in areas of high contour and complex geometries such as the stump. Before these systems can be used in a clinical setting, it is necessary to determine the reliability and accuracy of each system.

In order to assess the clinical validity of the Rincoe SFS and FSocket systems, a series of trials was conducted to evaluate different aspects of sensor performance, namely; accuracy, hysteresis, drift and the effect of curvature. The sensors were subjected to tests in flatbed and customdesigned pressure vessels. Overall results indicated an accuracy error for the Rincoe SFS system of 25% (flatbed) and 33% (mould), with a corresponding 15% (flatbed) and 23% (mould) error in hysteresis, and 7% (flatbed) and 11% (mould) drift errors. The FSocket system demonstrated an 8% (flatbed) and 11% (mould) accuracy errors, 42% (flatbed) and 24% (mould) hysteresis errors, and 12% (flatbed) and 33% (mould) drift errors. These findings indicate favourable results for the FSocket Pressure Measurement System compared to the Rincoe Socket Fitting System with respect to its accuracy errors only. Nevertheless, it is the authors’ belief that these systems are adequate in indicating areas of high pressure at the stump socket interface for clinical purposes, but both systems should be used with caution.

Rehabilitation of a person with a nonfunctional arm and a transtibial amputation with a short stump with fragile skin, multiple scars and a limited knee function presents a considerable problem. The best prosthesis was considered to be one with a rollon socket. Donning and cleaning of the socket however could not be done by the patient himself and it was therefore necessary to develop a device to permit the patient to perform these tasks independently. A case history is presented and the new device described.

This paper describes the experience with a transtibial amputation due to reflex sympathetic dystrophy. Because of lack of information about postoperative management in these cases, the medical history is provided together with a description of early mobilisation and technical information about prosthetic equipment.

A primer on limb prosthetics by A. Bennett Wilson Charles C. Thomas Publisher Ltd, Springfield, Illinois, USA ISBN 0–398–06900X, 1998 pp151, 93 figures