Case Study - Amputation in Disasters and Conflicts: Difference between revisions

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== Title ==
== Title ==
Add your content to this page here!
Poly-trauma with right below-knee amputation and left open tibial fracture with associated peroneal nerve injury.<ref>Lathia C, Skelton P, Clift Z, Chapter.6 Early Rehabilitation of Amputees. Lathia C, Skelton P, Clift Z. [https://resources.relabhs.org/resource/early-rehabilitation-in-conflicts-and-disasters/ Early Rehabilitation in Conflicts and Disasters.] London, UK: Handicap International. 2020. p133
</ref>
 
Thanks to Humanity and Inclusion for Case Study taken from [https://resources.relabhs.org/resource/early-rehabilitation-in-conflicts-and-disasters/ Early Rehabilitation in Conflicts and Disasters].


== Abstract ==
== Abstract ==
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Distressed six-year-old presented to an Emergency Medical Team with right below-knee guillotine amputation and left open tibial fracture with associated peroneal nerve injury.


== Key Words  ==
== Key Words  ==
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Poly-trauma, Amputation, Open Fracture, Peripheral Nerve Injury, Peroneal Nerve, Child, Trauma


== Patient Characteristics ==
== Patient Characteristics ==
A six-year-old child presented to an EM
A six-year-old child presented to an EMT for closure of a below-knee guillotine amputation, wearing a full leg cast on their other leg. On further investigation, it was revealed that this cast was hiding an open tibial fracture, with an associated peroneal nerve injury. The management of injuries to the non-amputated side was vital for the child to able to walk using a prosthetic.
[[Category:Rehabilitation in Disaster and Conflict Situations Content Development Project]]  
 
[[Category:Early Rehabilitation in disasters and Conflicts - Case Studies]]
To complicate matters, the child was distressed by their injury and terrified of health staff. They were accompanied by a relative (not their parents). Managing their distress and educating them and their caregiver became an essential part of early rehabilitation - building trust before any physical rehabilitation could begin.
[[Category:ReLAB Content Development Project]]
==Resources==
[[Category:Physioplus Content]]
[https://resources.relabhs.org/resource/early-rehabilitation-in-conflicts-and-disasters/ Early Rehabilitation in Conflict and Disasters,] Humanity and Inclusion
== References  ==
<references />
[[Category:Rehabilitation in Disaster and Conflict Situations Content Development Project]]
[[Category:Rehabilitation in Disaster and Conflict Situations]]
[[Category:Early Rehabilitation in Disasters and Conflicts - Case Studies]]
[[Category:ReLAB-HS Course Page]]
[[Category:Rehabilitation]]
[[Category:Course Pages]]
[[Category:Course Pages]]
[[Category:Case Studies]]
[[Category:Projects]]
[[Category:Projects]]
[[Category:Rehabilitation]]
[[Category:Amputees]]
[[Category:Nerves]]
T for closure of a below-knee guillotine amputation, wearing
 
a full leg cast on their other leg. On further investigation, it was revealed that this cast was hiding
 
an open tibial fracture, with an associated peroneal nerve injury. The management of injuries to the
 
non-amputated side was vital for the child to able to walk using a prosthetic. To complicate matters,
 
the child was distressed by their injury and terrified of health staff. They were accompanied by a
 
relative (not their parents). Managing their distress and educating them and their caregiver became
 
an essential part of early rehabilitation – building trust before any physical rehabilitation could begin.
 
Active exercise
 
Active exercise aims to improve muscle strength and mobility, reduce oedema, reduce muscle
 
atrophy, aid transfers and functional independence and aid psychological adjustment. Start active
 
exercises for residual limb and whole body as soon as possible, taking appropriate precautions
 
with any other injuries.
 
 
Core exercises
 
Core stability exercises are especially important with multiple limb injuries/patients with higher
 
level amputations
 
These exercises can start early, even on bed rest. Postural awareness is key, and continues
 
its importance through to prosthetic gait education. Kneeling is especially good for bilateral
 
transtibial amputations, including four-point kneeling in later stages. Hip extension and trunk
 
stability exercise can also be helpful in earlier stages.
 
Lower limb amputation exercises
 
It is important that the patient maintains their strength and range of movement, post-amputation.
 
The patient and their caregivers should be advised to keep all remaining joints moving throughout
 
their full available range, especially the joints above the amputated site (hip and knee) to prevent
 
contractures.
 
The following exercises are good basic strengthening and ROM.
 
Straight leg raise
 
Put your legs out in front of you
 
Tighten your thigh
 
Lift your leg off the bed
 
Hold for ten seconds
 
Slowly lower
 
Repeat ten times
 
Repeat the above with the other leg
 
Hip flexor stretch
 
Lie on your back, preferably without a
 
pillow
 
Bring your thigh towards your chest
 
and hold with your hands
 
Push your opposite leg down flat on to
 
the bed
 
Hold for 30 – 60 seconds, then relax
 
Repeat five times
 
Repeat the above with the other leg
 
Bridging
 
Lie on your back with your arms at the
 
side
 
Place a couple of firm pillows or rolled-
 
up blankets under your thighs
 
Pull in your stomach, tighten your buttocks
 
and lift your bottom up off the bed
 
Hold for five seconds
 
Repeat ten times
 
To make this exercise more difficult, ask your
 
patient to place their arms across their chest,
 
as shown in the picture
 
Hip abduction in side lying
 
Lie on your side
 
Bend the bottom leg
 
Keep hips and top leg in line with your
 
body
 
Slowly lift your top leg up, keeping your
 
knee straight
 
Slowly lower
 
Repeat ten times
 
NB Do not to let the patient’s hips roll for-
 
wards or backwards
 
Repeat the above with the other leg
 
Hip extension in prone
 
Lie flat on your stomach for ten minutes,
 
three time per day
 
Lie flat on your stomach, keeping your hips
 
flat on the bed left your leg off the bed
 
Hold for five seconds
 
Repeat ten times
 
Upper limb amputation pre-prosthetic exercises
 
Function, range and power of the upper limb are often neglected, but are key to good outcomes
 
and quality of life. Scapular range is very important if using upper limb for greater function, e.g.
 
following bilateral lower limb amputation, or a patient sustaining a triple amputation needing to
 
achieve getting on and off the floor independently. Also note that pectoral major/minor tightness
 
is very likely, due to greater sitting time, and needs to be counteracted.
 
All these exercises should be completed through your patient’s full available range, unless
 
indicated otherwise.
 
== Examination Findings ==
 
== References  ==
<references /> 

Latest revision as of 10:46, 1 June 2022

Original Editors - Naomi O'Reilly

Top Contributors - Naomi O'Reilly, Kim Jackson and Olajumoke Ogunleye      

Title[edit | edit source]

Poly-trauma with right below-knee amputation and left open tibial fracture with associated peroneal nerve injury.[1]

Thanks to Humanity and Inclusion for Case Study taken from Early Rehabilitation in Conflicts and Disasters.

Abstract[edit | edit source]

Distressed six-year-old presented to an Emergency Medical Team with right below-knee guillotine amputation and left open tibial fracture with associated peroneal nerve injury.

Key Words [edit | edit source]

Poly-trauma, Amputation, Open Fracture, Peripheral Nerve Injury, Peroneal Nerve, Child, Trauma

Patient Characteristics[edit | edit source]

A six-year-old child presented to an EMT for closure of a below-knee guillotine amputation, wearing a full leg cast on their other leg. On further investigation, it was revealed that this cast was hiding an open tibial fracture, with an associated peroneal nerve injury. The management of injuries to the non-amputated side was vital for the child to able to walk using a prosthetic.

To complicate matters, the child was distressed by their injury and terrified of health staff. They were accompanied by a relative (not their parents). Managing their distress and educating them and their caregiver became an essential part of early rehabilitation - building trust before any physical rehabilitation could begin.

Resources[edit | edit source]

Early Rehabilitation in Conflict and Disasters, Humanity and Inclusion

References [edit | edit source]

  1. ↑ Lathia C, Skelton P, Clift Z, Chapter.6 Early Rehabilitation of Amputees. Lathia C, Skelton P, Clift Z. Early Rehabilitation in Conflicts and Disasters. London, UK: Handicap International. 2020. p133
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