Cavanilles-Walker JM, Ballestero C, Iborra M, Ubierna MT, Tomasi SO
Lower limb amputations occur for many reasons.
No significant difference was reported between the prosthesis group and the wheelchair group with respect to types of mobility devices prescribed (i.e., prostheses and wheelchairs). This finding is especially important for the prescription of prosthetic knees for those with higher-level amputations, considering that all veterans who primarily used wheelchairs were also prescribed prostheses with microprocessor knees (C-Leg or Rheo Knee). Since the cost of a microprocessor knee could be substantial, prescription of such devices must also be based on the functional needs of the end user. A possible explanation for the prescription of microprocessor knee units is that the clinician determined at initial evaluation that the user required substantial stability during ambulation, stability that would be provided by these knee units. Current studies, emphasizing prescription models, only consider the recipient's age; demographic characteristics; health factors, including the presence of comorbid conditions; and cognitive abilities [25-26]. However, one must also consider users' functional performance with the devices and the importance the users give to the devices, because these critical factors have been found to contribute to successful prosthesis utilization.
Flexibility of the spine should be assessed clinically and radiologically. Patients’ standing coronal and/or sagittal deformity may decrease in supine or prone position due to mobile segments. Standing long-cassette anteroposterior and lateral radiographs, supine bending, lateral fulcrum and lateral flexion and extension radiographs may demonstrate the flexibility of the deformity. Consideration of the spinopelvic parameters is critical in the surgical planning. Bridwell classified spinal deformities into three categories based on curve flexibility: totally flexible, partially through mobile segments, and fixed deformity with no correction in the recumbent position.
5. The Orthotics can be repaired or adjusted.
Flexible deformities can be addressed with anterior-posterior or posterior only surgery not requiring any osteotomy. Sagittal balance is improved by lengthening the anterior column, either through an anterior or a posterior approach, using cages, structural allograft or structural autograft. The posterior column is then addressed with laminectomies when there is evidence of stenosis, facetectomies, and fusion with instrumentation.