A Double-Ring Harness for the Bilateral Above-Elbow Amputee
Thomas L. Maples, CP.
The problems of providing functional prostheses for the bilateral above-elbow amputee are well known to clinic teams throughout the country. Particularly difficult is the fabrication of an adequate harness-one which will take maximum advantage of the operating forces and excursions available without inadvertent cross operation. Moreover, for comfort, the harness must not "creep" up onto the patient's neck. In New Orleans we were confronted recently with a problem of this type. The ultimate solution involved the development of a somewhat unique harness configuration, or at least one that we had not seen described in the literature previously. We offer information on this procedure in the hope that it may be helpful to others with similar problems. Although our patient was an adult, the principle involved should be equally applicable to children.
The subject was an adult male, 41 years of age, who suffered the loss of both arms above the elbow in a farm-machinery accident. He was given emergency treatment at a clinic in a small town and was then transferred to a somewhat larger hospital where a mid-third, above-elbow amputation was performed on the right limb and a short above-elbow amputation was done on the left.
Several weeks postoperatively the patient was transferred to the Veterans Administration Hospital in New Orleans. The VA amputee clinic team was headed by Dr. Rufus Alldredge, assisted by Drs. Edward Haslam and Claude Garrett. Although it was fell that revision of the short left stump would be necessary, it was agreed that no further time should be lost in starting the rehabilitation program. A decision was made, therefore, to proceed immediately with the fitting of the right stump.
Measurements were made and a prosthesis fabricated for the right side. A shoulder-saddle, chest-strap harness was fitted. Interference with the surgical wound and dressing on the left limb might have occurred if a figure-eight harness had been used. Occupational therapy was begun immediately. The prosthesis included a Hosmer E-400-2 (forearm lift assist) elbow, a wrist-flexion unit, and a Dorrance 5XA hook.
When the sutures were removed from the left stump, a prosthesis of the same type was fabricated and fitted to that limb. The harness to power both arms was a bilateral figure X.
Considerable difficulties were experienced with this harness, the chief one being that the harness kept riding up onto the patient's neck. Numerous alterations were made to the harness, including a change to the Northwestern ring type. The ring-type harness did not solve the problem.
After these numerous harness modifications, the thought of using two rings welded together one above the other was conceived. The welded rings were later changed to figure-eight rings sawed out of 1/8" sheet-aluminum stock with a hole saw. Dimensional details of these rings are shown in Fig. 1 . The cut edges of the rings are smoothed by sanding and buffing.
The control strap for each arm ran from the top ring through the appropriate cable hanger and back to the lower ring. This arrangement seemed to eliminate the riding up of the harness and provided independent opening of each terminal device. Immediately the patient's performance improved vastly, and he was able to continue his rehabilitation program without further serious complications arising from the prostheses.
At one time an attempt was made to convert the control cables to the heavy-duty cable and housing (C-100-HD. 3/32"), but the loss of efficiency in the control system was not acceptable to the patient. This highly intelligent patient was aware of the magnitude of his problem. He was fully cooperative and his suggestions were helpful in determining the alterations made in the fitting of the prostheses. He has returned to his cattle farm where he is able to perform all the duties required for its operation.
Since the amputee discussed was not available for pictures, another amputee was used to illustrate the harness method (Fig. 2 ).
J. E. Hanger of Louisiana, Inc. New Orleans, Louisiana