Support for an Amputee where the Multidisciplinary Approach has been Flouted: Amputee Case Study

Original Editor ­ Mamy Andrianaly

Title

Support for an Amputee where the Multidisciplinary Approach has been Flouted

Abstract

A young man of 33 years old, living 280 km from our centre (the equipment centre of Madagascar or CAM based in Antananarivo) arrives home with his brother. It was amputated left leg in 1/3 means-1/3 lower level following a fall bike. His reference wasn't official. It has been informally advise by the surgeon in his community to come in our centre. The MDT approach is dislocated from his start because there wasn't P&O who has been consulted and given his opinion for the level of the amputation. In CAM, MDT (physician, P&O and physio) is in front of the traumatized young hope still find walking

Key Words

Mamy, Andrianaly, transtibial, traumatic, madà, Physiopedia

Client Characteristics

  • Demographic information:he's a man 33 years old, single, businessman, lives at 280 km in the north east of the capital of Madagascar (Antananarivo), in the region of Alaotra, one of the country's granaries. [1]
  • Has no particular medical disease previous
  • No known co-morbidities (diabetes, sickle cell anemia, hemophilia)
  • No previous care or treatment
  • He's a young healthy man before his accident

Examination Findings

In 24 April 2014
-SUBJECTIVE:
Patient history:

  • He's a young healthy man before his accident (fall of a motorcycle) occurred on 1st december 2013. His left leg was completely shredded, crushed and had to be amputated at the regional hospital reference in Ambatondrazaka (Alaotra region).[2]

Chief complaints:

  • Left knee flexion, difficult to reduce, with tenderness on the outer side of the distal stump (when touched)

Self report out come measures:

  • Walking perimeter (with crutches) = 3000 meters
  • Vital capacity = 3-4 cm


-OBJECTIVE:

Physical examination tests and measure:

  • Blood pressure at rest: 10/06
  • After exercises: 12/06
  • Weight: 86 kg
  • Height : 18 cm

-

ICF Findings

  • Body functions and structures:
  • Upper limbs: muscle strength, movable joints
  • Lower limbs : muscle strength, RoM normal
  • Impairments: bending left knee fixed, attempts to extend are painful
  • Activity limitations: standing position without walking aids ( with the healthy limb) is very limited
  • Participation restrictions: activities requiring 2 lower limbs are greatly reduced or O.
  • Environmental factors: need improvements (slopes, WC)

Clinical Hypothesis

Our clinical evaluation of the patient'main problem in the pre-fitting phase leads to the need of reducing the flexion of the left knee by a second surgery. If the young man isn't agree, his gait will be bad. If he's agree, he must follow physiotherapy exercises to have good stump and knee joint correct for fitting. Assessment may be set and the amputee's psychology prepared.

Intervention

Surgery on the left knee in October 2014 followed by a functional support for stump management and maintenance of joints (left knee and hip particularly)

Outcome

There was obtained a relative mobility of the left knee: maximum of extension but reduced bending at -40°

Discussion

The case I've choose concerns a a young man 33 young old who lost his left leg in a motorcycle accident in December 1st 2013 at a place situated 280 km from our centre in the north-east of the capital of Madagascar where there isn't no fitting service, so no P&O. There hasn't been a multidisciplinary team that could make a pre-assessment amputation. There was just the surgeon with his team block which should intervene urgently to avoid vital risk for bleeding. This has put us in difficulty to fit the amputee with a short stump and a knee joint locked in flexion. The amputee comes to see us 4 months later with all these complications and the CAM's team should strive to convince him for a 2nd surgery of the knee flexion contracture reduction. The young man was agree and the second surgery was been done on October 2014 with the outcomes followed: a complete extension but a limitation of flexion. We feel that physio-exercises twice per week are necessary to prepare the stump and the knee mobilisation before the fitting. It's one difficult case the CAM's team has to manage because it was so complex for the building of the prosthesis and in front of the social situation of this young man who must stop his activity. The fact that we cannot follow all the steps of assessment in the lower limb amputation put us in difficulties to fit this young man and stop a long time his social integration. Mobilisation of a lot of responsibles is necessary in our country. [3]

[4]

References

  1. Disability in Africa, http://www.ascleiden.nl/content/webdossiers/disability-africa
  2. Jerome Peter fredericks, 2012, Thesis, Description and Evaluation of the Rehabilitation programme for persons with lower limb amputations at Elangeni, paarl, South Africa
  3. Fedération Africaine des Techniciens Orthoprothesistes, www.fatoafrique.org
  4. Organisation Africaine pour le developpement des centres pour les Personnes Handicapées, www.oadcph.org