MUHIMBILI UNIVERSITY OF HEALTH AND ALLIED SCIENCES

INSTITUTE OF ALLIED HEALTH SCIENCES

DIPLOMA IN ORTHOPAEDIC TECHNOLOGY

TANZANIA TRAINING CENTRE FOR ORTHOPAEDIC TECHNOLOGISTS

FINAL EXAM CLINICAL PRESENTATION

CLASS : THIRD YEAR DIPLOMA

ACADEMIC YEAR : 2019/2020
CASE : LEFT TRANS-FEMORAL PROSTHESIS
REGISTRATION NO : 2017~02~11134
Table of Contents

1.0SUBJECTIVE ASSESSMENT......................................................................................3
1.1Personal Information.................................................................................................3
1.2. Diagnosis.................................................................................................................3
1.3. chief complain/ coming reason...............................................................................3
1.4. Case history............................................................................................................3
1.5. Past medical history................................................................................................4
1.6. Social economic activity.........................................................................................4
1.7. Living Environment..................................................................................................4
1.8. Activity Level..........................................................................................................4
2.0 OBJECTIVE ASSESSMENT.......................................................................................4
CLINICAL EXAMINATION.................................................................................................4
2.1. Visual Examination..............................................................................................4
2.2.0 PHYSICAL EXAMINATION...............................................................................5
2.2.1 Palpation............................................................................................................5
2.2.2. RANGE OF MOTION.......................................................................................5
2.2.3. Muscle Strength................................................................................................6
2.2.4. Special Tests....................................................Error! Bookmark not defined.
2.2.5. ASSESSMENT OF OLD PROSTHESIS.........................................................7
2.2.6. Problem with old prosthesis.............................................................................7
2.2.7. Gait Deviations of old prosthesis......................................................................7
3. CLIENT EXPECTATIONS.............................................................................................7
4. PRESCRIPTION............................................................................................................7
5. MATERIALS TO BE USED............................................................................................8
6. TOOLS TO BE USED....................................................................................................8
7. CHALLENGE.................................................................................................................8
8.ACHIEVEMENT..............................................................................................................8
9. RECOMMENDATION....................................................................................................8
10.TREATMENT PLAN......................................................................................................9
1.0 SUBJECTIVE ASSESSMENT
1.1 Personal Information

 Registration hospital number: 18-59-10

 Surname: Massawe
 Other name: Melkzedeck
 Sex: Male
 Date of birth: 29/11/1987
 Tribe: Chagga
 Religion: Christian
 Marital status: Single
 Occupation: Businessman
 Address: Sanya Juu
 Contact. No: +25767570318
 Weight: 63 Kg without device. With device 69 Kg
 Nationality: Tanzanian

1.2. Diagnosis

 Left Lower Limb Trans-Femoral Amputee

1.3. chief complain/ reason of coming.

 Study purpose and correction of minor problems from old prosthesis.

1.4. Case history

Mr.Meleckzedeck was involved in car accident in 24/05/2012 at Kenya which lead to

severe bone crush, tissues and disruption of blood vessels from the knee. He was
taken to Loitokitok District Hospital in Kenya for treatment and then referred to KCMC
for further treatment. On the same day of admission at KCMC hospital, they noticed
loss of sensation from the knee to the foot, and he underwent left transfemoral
amputation. He was discharged one week after amputation. He was fitted with his first
prosthesis at KCMC Orthopaedic workshop after 3months for rehabilitation
management in September, 2012. He used 4 prostheses and he got his current
prosthesis in 2017 at TATCOT.
1.5. Past medical history

 None related to the current condition

1.6. Social/economic activities

 Occupation : businessman
 Hobbies : likes listening to music and watching movies
 Family status : married with two children.

1.7. Living Environment

 He is living in rural area, and uneven surfaces are common in his Daily activities

1.8. Activity Level

 K3-. Unlimited community ambulatory with variable cadence

2.0 OBJECTIVE ASSESSMENT

CLINICAL EXAMINATION
2.1. Visual Examination

 He has Good vision

 No asymmetry of the shoulders
 Well oriented with the environment
 General health status: Good
 Upper limb function : Good
 Trunk examination: Good trunk muscles control
 Mental health status: Normal

Lower limb examination

 Amputated side : Left
 Amputation type : Transfemoral
 Level of amputation : Long stump of 27.5 cm
 Shape of Stump : Cylindrical
 Skin colour  : no discoloration
 Surgical scar
2.2.0. PHYSICAL EXAMINATION

2.2.1. Palpation
 Skin temperature is normal compared to the sound limb

 No bony prominence at distal end of the stump

 No edema

 No pain on the stump

 Has good sensation

 Muscular atrophy of amputated side.

 15 cm from the GT to mid-thigh on right side measures 55cm

 15 cm from the GT to mid-thigh on left side measures 40cm
 There is muscle atrophy of 15cm along the thigh

2.2.2. RANGE OF MOTION

RANGE OF MOTION (in degree)

RIGHT SIDE LEFT SIDE
ACTIVE PASSIVE HIP JOINT ACTIVE PASSIVE
120 130 Flexion 110 120
30 30 Extension 25 30
30 45 Adduction 45 45
40 30 Abduction 30 32
30 45 Internal rotation -
30 35 External rotation -
KNEE JOINT
130 145 Flexion -
0 5 Extension -
ANKLE JOINT
15 20 Dorsiflexion -
35 45 Plantarflexion -
2.2.3. Muscle Strength
MUSCLE POWER (OXFORD SCALE )
RIGHT SIDE HIP JOINT LEFT SIDE
Grade 5 Flexors Grade 5
Grade 5 Extensors Grade 5
Grade 5 Adductors Grade 5
Grade 5 Abductors Grade 5
KNEE JOINT
Grade 5 Flexors -
Grade 5 Extensors -
ANKLE JOINT
Grade 5 Dorsi flexors -
Grade 5 Planter flexors -
Grade 5 Invertors -
Grade 5 Envertors -
TOE
Grade 5 Flexors -
Grade 5 Extensors -

2.2.4. Special Tests

TESTS TEST FOR; RESULTS

SOUND SIDE:
Valgus Stress Test Medial collateral ligament Negative
Varus Stress Test Lateral collateral ligament Negative
Anterior Drawers Anterior cruciate ligament Negative
Test
Posterior Drawers Posterior cruciate ligament Negative
Test
Trendelenburg Test Stability of hip abductor muscle Negative
STUMP SIDE:
Tinel’s Test Neuroma Negative
Thomas Test Hip flexion contracture No flexion
contracture

2.2.5. ASSESSMENT OF OLD PROSTHESIS

Left Trans-femoral prosthesis with the following;

  Thermoplastic Quadrilateral socket design covered with PVC leather
 Endoskeleton shank.
 Single axis manual lock mechanical knee joint
 SACH foot size 26cm left
 Foam cover cosmesis and nylon stockinet

2.2.6. Problem with old prosthesis

 The old prosthesis is short
 Socket is not enough support on the anterial proximal brim. Due to this one
patient have misplacement of seat which ischial tuberosity slipping into
anterior.

2.2.7. Gait Deviations of old prosthesis

 Lateral Trunk bending towards the prosthesis side

 Terminal swing impact

 Internal rotation of foot

3. CLIENT EXPECTATIONS
 He expects a comfortable fitting prosthesis.
 Client expects a comfortable socket.
 Height of the prosthesis should be equal to the sound limb because former
one was short.

4. PRESCRIPTION
Left Lower Limb Trans-Femoral Prosthesis with the following:
 Socket design: ischial containment socket.
 Socket type: Laminated socket
 Suspension; suction suspension with valve.
 Prosthetic knee joint: 3R 36 with four bar linkage
 Shank : Endoskeleton shank.
 Prosthetic foot : SACH foot size 26 cm ( Left)
 Cosmesis : matters Foam cover and nylon stockinet

5. MATERIALS TO BE USED.
 P.O.P. Bandages
 P.O.P. Powder
  Ladies stockinet
 Perlon stockinet
 Carbon fiber
 Hard lamination resin
 PVA bags
 Color pigment
 Double face tape.
 Talcum powder.

6. TOOLS TO BE USED
 Surform blade (half round, flat and round)
 P.O.P knife
 Tailors’ tape
 Folding rule
 Tailors’ scissor
 P.O.P. scissor
 Vernier caliper or body caliper.
 Indelible pencil
 Wire mesh
 P.O.P. Bowl and spatula

7. CHALLENGE.

8.ACHIEVEMENT

9. RECOMMENDATION

10.TREATMENT PLAN
PLAN DATE
Patient assessment and measurement 31st /08/2020
taking
Modification and fitting of the negative cast 07/09/2020
Filling of negative cast and modification of 08/9/2020
positive cast
Lamination of the socket 08/09/2020
Trim lines and cleaning 09/09/2020
Assembling and bench alignment 09/09/2020
Static, dynamic alignment and finishing 10-13/07/2020
Patient presentation 18/09/2020

Date…18~09~2020 Signature…………………