The Very Young Traumatic Partial Hand Amputee: A Multidisciplinary Challenge
MARILYN ROGERS, B.S.R., P.T., SUSAN GARRET, B.S.R. O.T.R.D. BEAUCHAMP, M.D., F.R.C.S.C., AND P. GROPPER, M.D., F.R.C.S.C.
Sion is a five year old boy who suffered a traumatic partial hand amputation at the age of four years as a result of a motor vehicle accident. His medical history and subsequent rehabilitation is unique and will be described in this paper.
As a result of his extensive soft tissue damage the medical team had to decide between salvaging his hand or completely amputating his arm below his elbow. In an attempt to avoid a complete amputation, a team consisting of a physiotherapist, occupational therapist, psychologist, plastic surgeon and orthopedic surgeon worked intensively for 18 months to obtain maximum hand function.
As a result of his extensive soft tissue damage, fractured humerus, severe scarring and extensive tendon and nerve damage, skin, nerve and tendon grafting was required. In addition, pain management in such a young child required a unique approach in designing such a lengthy rehabilitation program. The therapy techniques that were utilized included joint mobilization, passive stretching and strengthening techniques, biofeedback, splinting and Jobst garments. In addition, prosthetics which include a cosmetic hand and alternate functional passive hand will be reviewed.
The team approach in Sion's case has been successful. He has readily accepted daily use of both prosthetics and is functionally bimanual.
This case illustrates the positive application of prosthetics for a child with a traumatic partial hand amputation.
B.C. Children's Hospital, 4480 Oak Street, Vancouver, British Columbia, Canada