The use of western components and materials for prostheses is prohibitively expensive in most developing countries. In addition, local customs and conditions vary considerably from those for which the prostheses were designed. For these reasons, a trans-femoral prosthesis has been developed in Pokhara, Nepal, using entirely locally available materials, and with a view to fulfiling local requirements as far as possible. This paper describes the materials and fabrication technique for the component parts of the prosthesis, the local conditions for which it was developed, and a three year follow-up of the first prosthesis issued. Only one serious design fault was discovered during this period, and a modification to the fabrication procedure introduced. The authors believe that if this trend continues, this style of prosthesis may be useful in the future for Nepali amputees and perhaps also in other countries, particularly where mass production of components is not practical.
were included. 28/38 (74%) successfully completed non-op treatment whereas 10/38 (26%) failed after a median of 44 days (range, 6-511) from the initiation of physical therapy. Of the 10 patients who failed, 9 (90%) sought treatment >30 days after the injury. Two of these patients had a subsequent surgery before final follow-up and were therefore not included in outcomes analysis. Follow-up was available for the remaining 7/8 patients (87.5%) who failed non-op treatment and for 22/28 patients (78%) who were successfully treated nonop. Mean follow up was 3.3 years (range, 2.0-5.9). Although there were no significant differences in outcomes scores between groups (Table1; p >0.05), those who sought treatment >30 days after injury demonstrated decreased postoperative SANE scores (p ¼ 0.002) and had 13.8x greater relative risk for failure of non-op treatment. Conclusion: Surgical decision making after acute grade 3 injuries is evolving. Based on our data, we conclude that (1) a trial of non-op treatment as warranted as successful outcomes can be expected even in those that eventually opt for surgery, and (2) oatients who present >30 days after their injury are much less likely to complete nonoperative treatment successfully.
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