Residual Muscle Contraction and Residuum Socket Interface Force in Men with Transtibial Osteomyoplastic Amputation

Abstract

In the transtibial osteomyoplastic amputation (TOA) technique, the distal ends of the tibia and fibula are surgically joined to form a ''bone bridge'' to stabilize the bony anatomy of the distal residuum. The distal-most muscles also are secured to reestablish a length-tension relationship. Unlike conventional amputation techniques in which the muscles are not secured and do not retain length-tension relationship, the TOA procedure is anticipated to allow muscles to actively contract and retain normal physiological function. In this case series, outcomes of the TOA procedure were investigated by measuring electromyography signals from the tibialis anterior and gastrocnemius muscles in the residuum and forces at the residuum socket interface (RSI) in unilateral transtibial amputees with TOA during three types of gait activities (self-paced walking, brisk 2-minute walking, and walking over a distance of 25 ft while carrying various loads). Results confirmed the presence of loadings at the distal residuum and the activity in the residuum muscles during these gaits. Furthermore, statistical analysis showed that when the distal RSI force variation was higher, the residual tibialis anterior muscle was more active compared with its activity at lower distal RSI force variation. (J Prosthet Orthot. 2013;25:151Y158.)

The effectiveness of the bone bridge transtibial amputation technique

“…Gait and weight distribution symmetry could help prevent overuse to the contralateral limb of the prosthesis user. 31,32 Furthermore, daily and chronic volume fluctuations may affect the quality of prosthesis comfort and use. During volume loss, it is crucial that the RL be able to tolerate the redistribution of pressure, particularly to the distal end, while not creating excessive pain or cause for skin breakdown.…”

“…Gwinn et al reported the preoperative differences between the bone bridging and non-bone bridging transtibial amputation in patients who sustained a wartime blast injury. Gwinn et al reported an average age of 23.5 (19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36) years. Functional level and prosthesis accommodation of the subjects were not reported.…”

Comparing Temporospatial Performance During Brisk and Self-Paced Walking by Men With Osteomyoplastic Transfemoral Amputation and Controls Using Pressure and Muscle Activation Peak Times

“…Vital signs and reports of perceived exertion were recorded to ensure participant safety ( 13 ). Pressure and muscle activation data were collected using the OU-PAM ( 3 , 14 ), which can capture 16 analog input channels at 1 kHz. It utilizes the STK525 ( 15 ) and ATEVK525 ( 15 ) boards for data acquisition.…”

“…Active gait performance is the primary, expected outcome ( 7 ). Mai et al ( 3 ) documented novel muscle activity in the distal OTTA residuum, and Dionne et al ( 8 , 9 ) found comparable work performance (gait, lifting, and carrying) in these same male participants with OTTA, as intact controls. Thus, investigators expected that men with OTFA would perform better or similar to controls, despite missing a knee joint system, shank, ankle joint system, and foot ( 4 ).…”

“…In those with transtibial amputation (TTA), there is evidence of active contribution to prosthesis control during gait by the distal-most muscles (i.e., anterior tibialis, gastrocnemius), specifically in adult men with osteomyoplastic TTA (OTTA) ( 3 ). However, little is known about the distal-residuum muscle activity or RSI pressures produced during brisk or self-paced gait performance by individuals with OTFA ( 4 ).…”