CREATIVE CORNER: SHOULDER PROSTHESES
Janet G. Marshall, CPO; Kathleen Wielatz; Janet Barber, RBP
Cosmetic prosthetic treatment for children with amputations or congenital absences involving the shoulder can be challenging. The importance of creating a natural replacement and allowing what function that remains is paramount for the patient to accept the prosthesis. In addition, the weight and comfort of the device factor into the whole picture.
A sixteen year old male presented with a recent forequarter amputation of the left shoulder secondary to an osteosarcoma. He was scheduled for ongoing chemotherapy for several months. It was mutually decided to make a passive arm for now, and a functional one in the future. Layers of plastizote were heated and formed directly onto the cast of his remaining shoulder, then sculpted to duplicate the right side. Grooves for the attachment bars of the endoskeletal arm were made into the plastizote prior to pulling a 1/8 inch surlyn over all. This provided a secure connection with added rigidity without additional weight. The clear plastic improved the cosmetics and distally was more flexible for body movement.
The second shoulder prosthesis was for a nine year old female with phocomelia of the left arm. Since her left hand was very functional, the objective was to allow movement, but provide a cosmetic arm. Once again, the layered plastizote was heat molded to the cast of her left side, wrapping around only the posterior side of her hand. This was then sculpted to create a fixed shoulder, matching the right side. Copolymer was vacuum formed over this, pulling the turntable friction elbow for mounting the forearm into the humeral section. The end result was a pleasing combination of function and cosmetics.
Children with disfigurements are challenged with maintaining their self-esteem. Passive devices like these offer the cosmetics and comfort levels that allow an improved basis of acceptance. Both patients and their parents indicated their personal approval with smiles and hugs, which were gladly received. ( Photo 4 , Photo 5 , Photo 6 )
Shriners Hospital for Children Tampa