Wednesday, November 30, 2022

FW: An interesting case.

Suman Kumar Panda

Dear List,

Original question:

Dear List,

Regards!!

Well again confused with a special
and interesting case: Age: 18month, Sex: Female, Left congenital
humeral deficiency partial (only a part of humeral head can be seen in
the glenoid cavity, no elbow unit, lower part of the extremity both
radius & ulna and all the Cs, MCs & phalanges are present with
good condition). Pt. has got good griping strength. No nerve
involvement.

The first thought that came into my mind was a
simple static trilateral sling. But, keeping in mind the developmental
stage and the gripping ability, I am now planning for a splint that
will start with a shoulder cap and chest strap and hold the forearm
into a fixed flexion attitude so that hand movements would be possible
and gravity would be eliminated caused by the lower part. I am confused
with the shoulder section (shoulder abduction angle) due to the
presence of the humeral head, I need to know what type of splint can be
beneficial for her, so that it can provide the best biomechanical
advantage to the remaining muscles of the forearm to carry out there
functions??

Simplicity always wins!!

I got two replies for the case and those are:

I have not had experience with a case such as this but my thoughts
lend to a sarmento style humeral splint with suspension provided
by a shoulder saddle or Figure 8 style prosthetic harness for
suspension. I’m not sure if that over does things in
regaurds to simplicity.
Good Luck

Jake Lindquist, CO, BeP
ASC Orthotics and Prosthetics

Suman,

Interesting case that you have described here. My suggestion would be to
fabricate an X-frame socket for this young girl, with shoulder cap and
obturator for her arm to fit through. A projection from the distal lateral
aspect of this X-frame would support and secure her forearm. This
projection could be possibly hinged to permit some prepositioning of the
forearm, for certain tasks.

Geoffrey Hall, C.P. ( c )The outcome of the replies are answered in the photos attached with it.

Thank You

Suman Kumar Panda
Resident, B.P.O.,
SVNIRTAR,
India
Phone: +919437856918
www.rehabeasy.blogspot.com

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