(Kiosk 1) Proper Prosthesis Fitting in an Adult Patient with Complex Bilateral Congenital Limb Deficiencies Without Prior Limb Surgery in a Multidisciplinary Amputee Clinic

Case Diagnosis: Bilateral congenital limb deficiency with right-sided Aitken-C Proximal Femoral Focal Deficiency and left-sided short femur with a completely dislocated, high-riding hip dislocation and a totally dislocated knee with tibia and fibula overlapping the femur.

Case Description or Program Description: 23-year-old female with PMH of renal failure of unknown origin s/p kidney transplant presented for evaluation for prosthesis. Team consisted of a physiatrist, physical therapist, two prosthetists, and case management. She remained mostly indoors and used bilateral crutches for mobility and did not have additional DME. Despite her limb deficiencies, she has never been evaluated for a prosthesis prior. She had severe ROM deficiency of left ankle in plantarflexion. Patient was unwilling to undergo surgical intervention to improve chances of ambulation.

Setting: Outpatient multidisciplinary amputee clinic in rehabilitation hospital

Assessment/Results: Successful prosthetic use in an adult with bilateral congenital limb deficiency is challenging in multiple aspects.This is further complicated by additional socioeconomic challenges including language barrier, travel time with limited transportation, and cultural traditions. Despite these barriers, the patient is still a good prosthetic candidate with high potential of functioning as a K2 ambulator.

Discussion (relevance): There are many challenging aspects to this case. The short RLE with total hip and knee dislocation presents increased difficulty to fit the LLE. Additionally, her restricted motion in plantarflexion on the left necessitates that she be fit in dorsiflexion with an open window for her forefoot to protrude from. Various hinge positions were discussed in an attempt to supply the patient with a knee which allows flexion while seated rather than a single device with no ability to flex. The short RLE presents both cosmetic difficulty with fitting the patient with a knee as well as the overall challenges of matching limb length.

Conclusions: Motivated adults with congenital bilateral lower limb deficiencies remain good prosthetic candidates despite multiple challenges.