Case Study Presents Complex Challenges, Unique Solutions

BANFF, Canada – A 22-month old female was presented to the Shriners Hospitals for Children in Tampa, Fla. with multiple congenital anomalies. The patient was recently adopted from Africa with little medical history. Although her upper extremity was normal and she was generally healthy, the lower extremity presented bilateral hip abduction tightness with limited range of motion. The young patient also presented flexion contractures at the knees greater than 90°, anteriorly bowed femurs and both feet were positioned backwards. Two months after her initial visit at Shriners, knee disarticulations were performed. Janet Marshall, CPO, LPO, Shriners Hospitals for Children and Association of Children’s Prosthetic-Orthotic Clinics (ACPOC) president, worked with the young patient on orthotic and prosthetic treatments soon after the amputations.

  . Janet Marshall, CPO, LPO
   Janet Marshall

“We first treated her with compression socks,” Marshall told the audience at the meeting here. “That alone was helpful. The biggest challenge was the abduction so I made a hip adduction orthosis with lots of strapping to put dynamic forces onto the extremities as well as for abduction and flexion.”

At 26 months, she was wearing her orthosis 10 to 12 hours a day. The girl’s adopted mother helped stretch her and did well to progress the hip abduction. One of the issues for Marshall was getting her in and out of the prosthesis.

“Her femurs were so bowed that getting her in and out was difficult,” she said.

But once the stubbies were made, the girl was brought in for intense therapy and according to Marshall, she was a marvelous patient. At 28 months, she was standing and moving with her stubbies, walking 40 feet with the assistance of a walker. At 32 months, the girl was given a new prosthesis with a more rigid band and feet, but no knees as she was still not as upright as she should have been. With some assistance, she was standing tall and walking. When she was brought back for intense therapy, Marshall worked on her balance and glute cueing to help her stay more erect. Abduction tightness and hip extension weakness will be a constant battle, according to Marshall.

“We are going to add the knees to the prosthesis,” Marshall said. “We hope for that to happen very soon. If we do surgeries, there is a possibility for setbacks and strength issues.”


For more information:

Marshall, J. Challenging case study of patient with bilateral knee disarticulations and abduction contractures. Presented at the Association of Children’s Prosthetic-Orthotic Clinics Annual Meeting. April 11-14. Banff, Canada.

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