S-3-01-01
AMPUTATION FOR DYSVASCULAR PROBLEMS
Georg NEFF (Free University of Berlin, Oskar-Helene-Heim, Berlin, Germany)
Arterosclerosis and Diabetes mellitus are the predominant origins for amputations of the lower limb in industrialised countries (still with the exception of Japan) and increasingly in Third World Countries. Worldwide a "black toe" leads to the automatism of a "so-called safe" above-knee/transfemoral amputation - to the disadvantage of the respective amputee.
Prior to amputation vascular surgery should be considered to save length and function. "Borderline amputation" minimizes the loss to toe(s) or partial foot leaving full weightbearing residual limbs; this includes special techniques for tenomyoplastic Chopart's, modified Pirogoff's or Syme's stumps.
The Burgess procedure for below-knee/transtibial myoplasty amputation provides partial weight-bearing with total contact sockets for short type below-knee prostheses. Unless there is no chance for a short transtibial stump, knee-disarticulation/through-knee amputation should be performed maintaining full weightbearing and a selfsuspending socket for a functional prosthesis.
Even in above-knee/transfemoral amputation "mini-myodesis and -myopiasty" may lead to a well shaped residual limb ready to be fitted even with an ischial containment socket for better comfort and functional use.
Mandatory for successful rehabilitation of the dysvascular amputee is the team approach - pre-dominantly in specialized rehabilitation facilities - to overcome the physiological and the psychical aspects of amputation.
S-3-01-02
Preliminary Investigation of Pelvic Obliquity Patterns in Amputee Gait
Dudley S. Childress, Ph.D. & Stephanie B. Michaud (Northwestern Univ. Chicago, IL USA)
We examined pelvic obliquity in six transtibial and three transfemoral amputees, all male, all unilateral, and have compared the time course of the pelvic obliquity between transtibial, transfemoral, and non-amputee gait over a range of walking velocities. Our results show that pelvic obliquity amplitudes diminish as the level of amputation increases. Pelvic obliquity tends to be larger during the early phase of sound-limb stance than during the early phase of prosthetic-limb stance. Most of the amputees appeared to hip-hike on the prosthetic side. This movement may be to facilitate clearance of the prosthesis with the walking surface. Transfemoral amputees tended to hip-hike during swing phase of both the prosthetic and the sound-side limbs. We conjecture that hip- hiking on the sound side is related to the transfemoral socket. Since hip-hiking involves expenditure of muscle energy we suspect it may be one of the reasons transfemoral walking usually requires more energy than transtibial walking, at similar speeds. Transtibial walking energy requirements may be greater than for non-amputee gait for the same reason. We observed that the transfemoral amputee with a quadrilateral socket had the smallest obliquity magnitude of all the amputees studied. Kinematics of amputee gait, in the coronal plane, have not been studied extensively. We conjecture that sockets allowing near normal obliquity relationships could reduce energy consumption and lessen shock, enabling amputees to walk faster and farther than if this motion is inhibited.
