1Pathak R, 1Pathak R, 2Dabai N, 3Recio A
1Kennedy Krieger Institute, Baltimore, MD, USA; 2The Johns Hopkins University School of Medicine, BALTIMORE, Maryland, United states; 3The Johns Hopkins University School of Medicine, The International Center for Spinal Cord Injury at Kennedy Krieger Institute, BALTIMORE, Maryland, United states
The role of trans-femoral prosthesis in a tetraplegic SCI
Historically, lower extremity prosthetics for individuals with spinal cord injury (SCI) have been viewed to provide cosmetic value. There is little in the literature demonstrating the additional benefits lower extremity prosthetics can serve these individuals. Prosthetics can play a role by helping with transfers, weight distribution, balance, enhance mobility and function.
This is a 33M who suffered a two-story fall with loss of conscious and was not found until 2 days following the incident. He sustained polytrauma resulting in cervical fractures classed as a C8 ASIA A SCI, bilateral lower extremity compartment syndrome, left extremely proximal trans-femoral amputation with an incredibly short residual limb.
Given his dramatically high amputation, his residual limb would slide underneath him with sit pivot transfers or while rotating on varying surfaces, which placed the limb at risk for further trauma and skin breakdown. As a result, he was fitted with a left trans-femoral prosthesis.
Considering the limited literature on the functional aspects of prosthesis in tetraplegics this case caught our attention.
After receiving the left lower extremity prosthesis he reported overall improvement in function. He reported overall improved functional ability. He was able to safely transfer to and from his wheel chair without concern for his residual limb getting trapped and injured. He was able to rotate to his right side while in a seated position with ease which he could not do prior. It provided him with improved balance while sitting upright. He is now using a stander which allows him to bare weight evenly onto his right leg as well as his short left residual limb. There has been research that lack of sensation in a limb usually is a contraindication for prostheses because of the increased risk for pressure ulcer formation at the socket interface (1). Given the lack of research there should be a push to understand the SCI patient with relation to prosthetics and their use to enhance function in tetraplegics.
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