Fitting & Suspension Techniques for a Transhumeral Amputee with Burn Injuries: A Four Year Retrospective Case Study

A firefighter with burn injuries demonstrated fitting challenges regarding comfort and suspension of a functional upper limb prosthesis. This case study introduces a transhumeral-transfemoral patient who was injured during a volunteer firefighting incident. The patient sustained several injuries which resulted in amputation of the right leg just proximal to the knee and a transhumeral amputation of the left upper limb. The patient has full range of motion in both shoulders and elbows, yet the strength and dexterity of his right hand has been compromised. This individual sustained burns to 60% of his body, including the skin on his left transhumeral residual limb. Due to the delicate nature of his skin, a suction socket was contraindicated. Over the next four years, different types of custom and non-custom locking and cushion liners were utilized for patient comfort and suspension of both a myoelectric and a conventional (body-powered) prosthesis. The integration of electrodes for dual site myoelectric inputs offered additional challenges that compromised the suspension provided by silicone suction. Shuttle locks, lanyards, and proximal locking mechanisms were used, and the advantages and disadvantages of each system will be compared. This case study will follow the progression of suspension techniques, interface designs, and other clinical challenges faced by the patient and the clinicians involved with the fitting. As the patient progresses toward his imminent evaluation for Targeted Muscle Reinnervation surgery, his existing design must be modified to allow additional EMG sites. The challenges of this firefighter’s progressive fitting and treatment will be detailed in the discussion.