Difficult case-AK/BK

Schafer, Kristin

Hi All,
We have a 17 yo young man who entered our hospital system with meningitis
a few months back. (The other teen who had the same strain died.) The result
of the disease left him with transtibial and transfemoral amputations, no
fingers on either hand, limited wrist motion ( I believe he has difficulty
extending, but can use flexion), serious skin grafting on his wrists and
forearms, and I believe he also suffered some brain injury. This is all I
know so far. (I have yet to meet this young man.) The physiatrist gave me a
heads up that they are thinking of getting him moving towards prosthetic
rehab next in a few weeks.
My questions are: What would your prescription be for his AK and BK
prostheses? Are people able to don liners without fingers? Or are they
better off with sock fits? (I am unsure if there is significant skin
grafting on the lower extremity.) What other considerations come to mind?
I’m thinking we’ll have to use a lot of larger “loops” somehow affixed to
socks to assist in donning. What would be the best method of suspending
these prostheses? Would you train on one type of knee first and then switch
as his function improves? Do I cast and fabricate both limbs at the same
time ( or BK first).
Obviously, I’d love to learn from your experiences.

Thanks! Will post anonymously when all responses are in.

Kristin Schafer, CP, CP(c)

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