[Distal femur fracture in a woman with a lower limb prosthesis.] / Distale femurfractuur bij vrouw met onderbeenprothese.

BACKGROUND: People who use a lower limb prosthesis can fracture their distal femur after a trivial fall; however, this kind of fracture is uncommon. CASE DESCRIPTION: A 53-year-old woman with a trans-tibial prosthesis fell in her kitchen. She felt pain just above the socket of the prosthesis, was unable to get up and her knee and leg were swollen. Radiographic imaging showed a distal femur fracture, for which she received a non-operative treatment with a stump cast. In consultation with the rehabilitation physician she received a conventional lower limb prosthesis after consolidation of the fracture. She mobilised adequately and was able to resume her activities at home and at work. CONCLUSION: Distal femur fractures in patients with a lower limb prosthesis can be recognised through pain just above the socket of the prosthesis. Conservative treatment, including the use of a stump cast, followed by mobilisation with an adapted prosthesis under supervision of a rehabilitation physician often results in a good outcome in terms of functionality.

Variation in measurements of transtibial stump model volume: a comparison of five methods.

OBJECTIVE: To determine the right moment for fitting the first prosthesis, it is necessary to know when the volume of the stump has stabilized. The aim of this study is to analyze variation in measurements of transtibial stump model volumes using the water immersion method, the Design TT system, the Omega Tracer system, circumferential measurements, and anthropometric measurements. DESIGN: Nine stump models were measured on two occasions, each consisting of two sessions. In each session, two observers measured the model using each of the five methods. The grand mean volume for each method was calculated. Variance components and their two-way interactions were calculated of the measurement conditions. Repeatability coefficients were calculated for each method. RESULTS: The grand means of the five methods show systematic differences in volume measurements. Error variance was small (6.4%) relative to the total variance. Method and interaction between stump model and method contributed 82.6% to the error variance. Repeatability coefficients of the methods ranged from 45 ml for the Omega Tracer system to 155 ml for the anthropometric measurements. CONCLUSIONS: Error variation in measurement results can be attributed for 82.6% to measurement method and interaction between stump model and method. The Omega Tracer system had the smallest repeatability coefficient, indicating that it is the most reliable method.

Skin problems of the stump and hand function in lower limb amputees: A historic cohort study.

The aim of this study was to investigate the relationship between liner-related skin problems of the stump in patients with a lower limb amputation and impaired hand function. Sixty patients who were treated in a rehabilitation hospital from 1998-2006 were included in an historic cohort study. Data were collected concerning the amputation, skin problems of the stump, co-morbidity, hand function, the prosthesis, liner use and mobility score. The study population consisted of 50 trans-tibial and 10 knee disarticulation amputees, 43 male and 17 female, with a mean age of 62.3 years. The majority (63%) had a vascular reason for amputation. Blisters, folliculitis, rash and surface wounds on the stump were operationalized as being liner related. In patients with an impaired hand function, 70% had experienced liner-related skin problems of the stump, whereas 32% of the patients with a normal hand function had experienced skin problems (p = 0.035). This study shows that impaired hand function poses an increased risk for skin problems in the amputation stump in patients with a lower limb amputation and liner use in their prosthesis.

A patient with donning-related stump wounds: a case report.

A patient suffering from diabetes and a trans-tibial amputation presented with stump wounds caused by improper donning of the liner. His diminished hand function resulted in improper donning, with air being trapped between the liner and stump. This caused blisters on the skin after loading the prosthesis.

[Deep venous thrombosis in an amputation stump]. / Diepveneuze trombose in een amputatiestomp.

A 34-year-old patient underwent a knee exarticulation amputation and developed symptoms of pain, redness and swelling of the stump in combination with a feeling of tightness in the chest. These symptoms were first attributed to muscle pain and exertion but further examination revealed deep venous thrombosis (DVT) of the stump and a pulmonary embolism for which he was treated with nadroparine and acenocoumarol. Shortly after treatment he could resume the use of the prosthesis. A DVT in the amputation stump is not frequently encountered, but is a serious complication that can, together with a pulmonary embolism, be life threatening. The literature mentions an incidence ranging from 0-12%. Physical examination is often not conclusive and further examination of the patient with duplex scanning is necessary, with a ventilation-perfusion scan if a pulmonary embolism is suspected. Patients with a lower extremity amputation have a higher risk of developing a DVT because of immobility and increased venous pooling in the residual limb. Symptoms of a red, swollen, warm and painful stump should trigger the physician to suspect a DVT.

Literature review of the possible advantages of silicon liner socket use in trans-tibial prostheses.

The silicon liner socket has been used in the trans-tibial prosthesis since the 1980s. Silicon liner sockets are sleeves of silicon material that are rolled onto the stump and fix the prosthesis to it. The producers of the liners propagate many advantages in their use i.e. better suspension of the prosthesis, protection of the stump skin and improved cosmetic appearance. This review was performed to find objective documentation in the literature in support of the advantages in prosthetic fitting and use of silicon liners. A medline search was performed with the key words: "silicon liner socket, Icelandic Roll On Silicon Socket (ICEROSS), trans-tibial prosthesis, lower leg prosthesis and stump sockets". Six articles remained after application of the selection criteria. In two studies clinical examination was done while in the rest questionnaires were used to collect data. The indication for amputation varied from vascular insufficiency, diabetes mellitus and infection to trauma. Most studies mentioned improved prosthetic suspension compared to the conventional supracondylar fitting. Also the walking performance improved with less use of walking aids. There were reports of positive but also negative effects on the skin such as excessive perspiration and itching. Patients had a general preference in prosthetic appearance in favour of the prosthesis with a silicon liner. Further research is needed with the use of objective clinical parameters and a homogenous study group objectively to find advantages in the use of the silicon liner socket in the trans-tibial prosthesis.