Prosthesis After Amputation For Scleroderma
Dr. B.G. Spivak
Published in Orthopedics, Traumatology and Prosthetics, Volume 20, Page 73, September 1959, Moscow, USSR
Editor's Note: Orthopedics, Traumatology and Prosthetics is a journal published in Moscow and received by The American Orthotics and Prosthetics Association in exchange for the Orthopedic and Prosthetic Appliance Journal.
We are anxious to publish abstracts of the articles in it directly related to prosthetics and orthotic appliances. We are indebted to Elliott Markell of Markell Shoe Company for a review of the following article and to Dr. Drillis of the Prosthetic Devices Study of New York University for a translation. It is our hope to publish other abstracts in succeeding issues of the Journal.
Galina K., 29 years old, entered the Prosthetics Institute in August 1957.
At the age of 3, after scarlatina and diphtheria, she developed a swelling scleroderma which chiefly affected the distal portions of the left leg and left arm.
At the age of 12, she walked with crutches, with only the right lower leg for support. She was unable to walk on the left leg because of the contraction of the hip and knee joints.
Although she was given systematic medication, physical and spa treatments, the scleroderma grew worse, and only in the last five years was it noted that the swollen parts had healed. On the left forearm and left hip, the damaged tissue was being replaced with normal skin, and trophedema on the feet had healed up.
At the time of admission to the hospital, it was observed that there was a marked shortening and atrophy of the left shin and foot and also a contraction of the left hip (150°) and left knee joint (90°). The amount of blood flow in the left thigh was determined with the aid of radio-active isotopes and was found to be two to three times less than on the right side.
It was decided to do an amputation on a level with the lower third of the thigh. As a relative contraindication was the scarred skin on the medial surface of the thigh. The amputation was performed directly above the epicondyles of the femur. Healing came at the end of the first month with a moderate sized mobile scar forming on the end of the stump.
At this point, preparation for the prosthesis was begun including physical therapy procedures, massage of the stump and gymnastic exercises to eliminate the contraction of the hip joint. During one month the patient learned to walk with the leg in a plaster of Paris prosthesis. Thereafter a wooden prosthesis without a lock in the knee joint was used.
The fabrication of the prosthesis was complicated because the stump of the left thigh was severely atrophied. It was almost without subcutaneous fatty tissue, and the skin in some places had changed to scar tissue. Besides, it was noted to have a contraction of abduction of the left thigh in a range of 20 degrees.
The prosthesis was constructed with careful attention to the pecularities of the stump. the thigh socket was oriented outward in relationship to the knee joint. The alignment of the socket was based on the results of the contraction examination—a little bit forward and outward. The internal anterior surface of the socket, surrounding the end of the stump, was covered with foam rubber to prevent painful contact with the hard wall of the socket.
Investigation six months after discharge from the hospital showed that Galina is walking well on the prosthesis with a cane in her right hand. She does not complain of pain.
This case merits study because it is of a kind seldom seen—also because of the unusual character of the prosthetic procedure.
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