Solving Individual Problems with Partial Hand Prostheses
J. Tomaszewska A. Kapczynska D. Konieczna J. Dembinska W. Miedzyblocki
In recent years more and more patients with upper-limb mutilations have applied to this Rehabilitation Department for prosthetic services. Mostly they are young people for whom cosmesis of the prosthesis plays as important a role as function. In prescribing the best type of prosthesis for each of these patients it is necessary to take into account not only the extent of the amputation but also the level of intelligence and the professional requirements of each individual. In this article we present two such patients. Although these patients were no longer children, their treatment exemplifies applicable to all ages.
Patient J.B. at 32 years of age, while working on a hydraulic press, suffered the partial loss of both his hands (Fig. 1 ). After his wounds had healed, he was able to care for himself without aid; he could eat, dress and undress himself using both his stumps. However, he encountered difficulty in performing precise functions such as writing, buttoning his shirt, etc. After the accident he was not able to return to his former job and it was necessary to teach him a new profession. To this end he had to attend school. To give him new manipulating possibilities he was fitted with prostheses bilaterally. For his right hand he was given a prosthesis with a metacarpal socket and a split hook of the Dorrance type. For his left hand he received an epoxy resin prosthesis. In order for the patient to obtain maximum use of his prostheses it was necessary to equip him with individually designed aids such as: a penholder (Fig. 2 ) with which he was able to write for a couple of hours; a metal ring which could be used to carry a leather case (Fig. 3 ); a buttoning aid (Fig. 4 ), a knife-holder and a grasping device (Fig. 5 and Fig. 6 ). For cosmetic purposes the patient was also provided with cosmetic gloves (Fig. 7 ).
The patient is satisfied with his prosthetic aids which enable him to continue his studies in a public secondary school. He always carries all his assistive devices with him.
The second case presented is patient T.S. who is 22 years of age. Both her hands were crushed by an electric chaffcutter. In the Surgery Department partial hand amputations in the metacarpal region, with retention of the thumb, were performed (Fig. 8 ). Skin losses were covered with grafts (Fig. 9 ).
After her wounds had healed the patient was able to perform all her activities of daily living but only by using both hands together. In the orthopaedic workshop, necessary aids were designed for this patient and fitted to her. Hooks made of stainless-steel flat bar were riveted to the stump sockets which are of laminated plastic. The sockets encase the stumps only to the level of the wrist joint, so that palmar- and dorsiflexion movements of the stumps are unrestricted. The sockets are fastened to the stumps with "Velcro" straps. Leather straps attached to additional cuffs applied above the elbows prevent the sockets from sliding on the stumps, while allowing pronation and supination movements (Fig. 10 and Figs. 11 and 12 ). The patient was fully trained in the Rehabilitation Department; she was satisfied with her prosthetic aids and accepted them for home use. Conditions changed after a child was born. At that time she stopped using her prosthetic aids in attending to the needs of her newborn baby.
- In deciding the type of prosthetic equipment necessary in cases of bilateral hand injuries, the functional possibilities of the remaining stumps should be thoroughly analyzed.
- The prosthetic equipment should be appropriate to the patient's individual needs and occupation.
- With young persons cosmesis should be taken into account since even a good functional solution will be rejected if it does not meet cosmetic requirements.
This paper discusses the fitting of prosthetic aids to two patients with traumatic partial hand amputations bilaterally. Attention is drawn to the vocational and psychological factors which influence the use of prosthetic aids by the patients.
Department of Orthopaedic Surgery and Rehabilitation Institute of the Academy of Medicine Poznan, Poland