An Easy-to-Fabricate Temporary
Syme's Prosthesis
John E. Rooney, Prosthetist
Michael S. Pinzur, M.D.
Introduction
The Syme's ankle disarticulation amputation has been used sporadically for many years in the
treatment of major foot trauma, congenital anomalies, tumors, and infections, when a functional
heel pad can be preserved.2 Wagner has popularized the twostage technique in the
treatment of non-re-constructible, generally diabetic, peripheral vascular insufficiency.
3These patients walk better and have a decreased metabolic cost of walking as
compared with similar patients amputated at more proximal levels.4 Early
postoperative prosthetic limb fitting follow Stage II of the Wagner procedure has generally been
accomplished with a non-removable, total contact plaster cast.1 Due to residual
limb shrinkage, maturation, and the risk of infection or wound failure, frequent cast changes are
necessary for wound access. The removable "Canadian-type" socket described and the direct
load transfer (end-bearing) capacity of the Syme's amputation make it possible to accommodate
volume and shape changes easily by adding prosthetic socks or inner wall padding, and also
eliminate the need for frequent cast changes. The patient can generally proceed to definitive limb
fitting in a short period of time following Stage II.
Technique
Ten to 14 days following Stage II, the patient dons two thin cast socks which serve as
an interface spacer. The largest distal circumference and the equivalent proximal circumference
are marked medially and dictate the size of the medial window and the felt pad to be used for
the opening.
A 1/4" felt pad is skived on the proximal, distal, and posterior edges, and glued in place
medially. Standard immediate postoperative casting techniques are followed to fit the patient with
a rigid dressing.
The medial window opening is then cut open. Three additional layers of plaster wrap are added
to the medial window, which is replaced and secured with fiberglass cast tape. The rubber
walking heel is aligned and attached similarly with fiberglass cast tape. The medial window is
again cut out; however, only the proximal, anterior, and distal edges are cut, while the posterior
portion is left intact to act as a hinge (Figure 2)
. The edges are cut 3/8" away from the original
cuts, and this larger section acts as a positioning lip for the original piece. The plaster window
is then removed and glued to the fiberglass window. The felt pad is partially removed from
placement of a single rivet through the middle of both sections to secure the VelcroŽ closure
strap (Figure 1
and Figure 2
) and then prepositioned.
Conclusion
This system allows early weight-bearing and the convenience of removability for the patient,
while allowing the treatment team access to the wound.
John E. Rooney, prosthetist, is with the STAMP (Special Team for Amputation, Mobility and Prosthetics/Orthotics) Team, Hines Veterans Administration Hospital, Hines, Illinois.
Michael S. Pinzur, M.D., is an Associate Professor of Orthopaedics and Rehabilitation at Loyola University Medical Center, 2160 South First Avenue, Maywood, IL 60153.
References:
- Burgess, E.M., R.L. Romano and J.H. Zettl, "The Management of Lower
Extremity Amputations," United States Government Printing
Office, 1969, pp.24-33.
- Harris, R.I., "The History and Development of Syme's Amputations," artificial
limbs, 6(4), april, 1961.
- Wagner, F.W., Jr., "A Classification and Treatment Program for Diabetic,
Neuropathic and Dysvascular Foot Problems," Instructional
Course Lectures, The American Academy of Orthopaedic Surgeons, 28, 1979, pp.143-165.
- Waters, R.L., J. Perry, D. Antonelli and H. Hislop, "Energy Cost of Walking of
Amputees:
The Influence of Level of Amputation," Journal of Bone and Joint Surgery, January, 1976, 58A,
pp.42-51.
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