Summary: Absence of the proximal upper limb, whether congenital or acquired, has a profound impact on quality of life. Targeted muscle reinnervation (TMR) was originally developed to improve functional control over myoelectric prostheses; however, it has also been shown to decrease phantom limb pain and neuroma pain as well as prevent neuroma formation. In children, whose rates of prosthetic use are considerably lower than adults, the effects of amputation on limb function can be devastating. To date, there is very little literature regarding the use of TMR in children. In this case report, we review the current literature and present the case of a 9-year-old boy with a transhumeral amputation secondary to a traumatic injury who underwent acute TMR at the time of wound closure. At 22 months follow-up, the patient is doing well with minimal pain, no evidence of neuroma formation, and signs of muscle reinnervation.
Partial hand amputations (PHA) are amputations occurring distal to the wrist and can involve the complete or partial loss of the thumb, digits, and/or transmetacarpal regions. 1 The functional and psychosocial impacts from the loss of either hand at any level cannot be understated. Some of the consequences of experiencing a PHA include negative perceptions of wholeness, limitations in independence, altered social interactions, and difficulty maintaining employment. [2][3][4] Partial hand prostheses may greatly mitigate these limitations when reconstructive routes are unfeasible or inadequately restore hand form and function. 1 Using SCARE criteria, 5 we present a case of a 30-year-old warehouse worker who sustained degloving amputations of digits 2-5 through the proximal phalanges. Multidisciplinary collaboration facilitated a successful fitting with a partial hand prosthesis that improved hand form and function. CASE REPORTA previously healthy, right-hand dominant, 30-year-old man presented to our trauma 1 hospital for a crush avulsion injury to the left hand after being caught between two industrial rollers at work. The patient's previous medical history was noncontributory, and his social history was negative for tobacco or recreational drug use. The left hand showed substantial degloving with amputation of the index through small fingers through the proximal Related Digital Media are available in the full-text version of the article on www.PRSGlobalOpen.com.
Purpose: Partial hand amputations are devastating injuries that often negatively affect individuals and communities. Partial hand prostheses can mitigate the burdens of living with an amputation, especially when reconstruction alone cannot restore form or function. However, hand surgeons may be unfamiliar with these newer devices because the prosthetic field is rapidly progressing. Methods: An electronic survey was distributed to hand surgeon members of the American Association for Hand Surgery with the intent of assessing surgeons’ familiarity with partial hand prosthetic devices and their clinical applications. Survey items used Likert 5-point scales, rank order, multiple-choice, and yes/no question formats. Responses were compared by training background (orthopedic or plastic surgery) and by years of experience (≤10 years in practice or >10 years in practice). Results: Overall, hand surgeons are unfamiliar with modern partial hand prosthetic devices. Most of the cohort denied working within a multidisciplinary hand team (76.2%) or consulting with a prosthetist prior to revisional surgeries (71.4%). Restoring gross motor function and reducing pain were important outcomes to the cohort (4.42 and 4.17, respectively). Plastic trained hand surgeons were more likely to list toe-to-hand transfers as treatment options for multilevel digital amputations ( P = .03) and transmetacarpal amputations ( P = .02). Senior hand surgeons were more likely to suggest no treatment for partial thumb amputations ( P = .02). Conclusions: Expanding surgeon knowledge and encouraging collaboration within a multidisciplinary team may enhance amputee care.
The validation of myoelectric prosthetic control strategies for individuals experiencing upper-limb loss is hindered by the time and cost affiliated with traditional custom-fabricated sockets. Consequently, researchers often rely upon virtual reality or robotic arms to validate novel control strategies, which limits end-user involvement. Prosthetists fabricate diagnostic check sockets to assess and refine socket fit, but these clinical techniques are not readily available to researchers and are not intended to assess functionality for control strategies. Here we present a multi-user, low-cost, transradial, functional-test socket for short-term research use that can be custom-fit and donned rapidly, used in conjunction with various electromyography configurations, and adapted for use with various residual limbs and terminal devices. In this study, participants with upper-limb amputation completed functional tasks in physical and virtual environments both with and without the socket, and they reported on their perceived comfort level over time. The functional-test socket was fabricated prior to participants' arrival, iteratively fitted by the researchers within 10 mins, and donned in under 1 min (excluding electrode placement, which will vary for different use cases). It accommodated multiple individuals and terminal devices and had a total cost of materials under $10 USD. Across all participants, the socket did not significantly impede functional task performance or reduce the electromyography signal-to-noise ratio. The socket was rated as comfortable enough for at least 2 h of use, though it was expectedly perceived as less comfortable than a clinically-prescribed daily-use socket. The development of this multi-user, transradial, functional-test socket constitutes an important step toward increased end-user participation in advanced myoelectric prosthetic research. The socket design has been open-sourced and is available for other researchers.
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