How To Treatment For Particular Deformities - Physical Weakness ?

The two common hip deformities are flexion and abduction. To test the flexion deformity at the hip we must eliminate lumber lordosis by flexing the opposite hip fully and extended the affected hip (Thomas test) and check.

All joint movement in supine and prone, elimination trick movements, The ilio tibial band contracture also contributes to the flexion and abduction at the hip.

Soutter’s Operation - Flexion deformity hip requires extensive release, including the muscles in the anterior aspect of the thigh Sartorius, rectus femoris, iliopsoas, anterior hip capsule and other tight structures. Tension in the femoral nerve and vessels may prevent correction of more than 45% fixed flexion deformities; any additional correction can be obtained by subtrochanteric extension osteotomy. Severe flexion deformity may be prevented by early tenotomy of the psoas.

Yount’s Operation- Abduction deformity hip while the hips are in extension is because of contracture of anterolateral structure. In this operation there is division of the tensor fascia late at it’s origin together with release of any other tight structure on the anterolateral aspect of the hip. It may also be necessary to divide the ilio and lateral intramuscular septum.

"Knee Flexion"

Positioning - Prone lying with straight knees, long leg sitting with straight knees on the floor. Use gaiters in sitting and standing.

Surgical Treatment - The subcutaneous method of the division of the hamstrings is sufficient for the milder contractures. Care must be taken to avoid damaging the femoral or popliteal arteries and the lateral papliteal never, which could lead to haemorrhage or foot drop.

Posterior Capsulotomy - The illo tibial band is divided transversely and the personal nerve isolated. The biceps tendon lengthened in a Z manner. The capsule is stripped upward from the posterior aspect of the femur after incising it. A medial incision is now made above the adductor tubercle to below the joint line. A similar stripping is carried out on this side. A plaster of Paris cast is applied from ankle to groin with the knee fully extended. Weight bearing after 24 houre in the cast and intensive quadriceps exercises. The cost remains on for 2 to 3 weeks and then a posterior gutter splint is used and physiotherapy started.

Knee Hyperextension- The child given the position of sitting on chair and crook sitting. If the child is standing already, it should stand with posterior knee splint preventing hyperextension. Use shoes with high heel to throw child’s weight into knee flexion posture if his plantar flexors are not shortened.

"Surgical Treatment"

Harrington Rod - This consists of a longitudinal rod surgical fixed by hooks to the soine above and below the deformity. The rod can extend and elongate the spine. A compression metalwork system is placed on the convex side of the spine, pulling on the vertebral element above and below, so that the convexity is shortened. Using the two system it is generally possible to achieve an appreciable correction of the Cobb angle for mobile or flexible curves.

Walking frames or walkers are more stable than the other because their bases are quite and the centre of gravity falls within the base. They are prescribed for debilitated or people who are prescribed or elderly people who are usually confined to home, unable to climb stairs, and who have been advised not to venture outdoors.

A patient is not usually given a walking frame unless he is not able to walk even with walking sticks, or crutches, as the pattern of gait acquired in a walking frame is difficult to change. There are three main type of walking frame.

• The standard walking frame, including the pulpit frame.

• The reciprocal walking frame.

• The rollator.

Advantages of the Walking

• Allows maximum stability 4 point contact on floor.

• The reciprocal walking frame.

• The rollator.

Rollators-

A rollator is a walking with two small casters at the front and two short legs at the back, protected by rubber ferrules. Care must be taken when recommending a rollator for elderly patients as it may roll too far forward and they may lose their balance. The rollator is best suited for children who may find it difficult to lift walkers.

The patient holds the handgrips, lifts the rear legs just off ground, wheels the rollator forward a short distance, lowers the rear legs on to the ground and then walks forward into rollator holding the hand-grips.

Conclusion

Disability limitation in a lower extremity amputee is extremely gratifying, because with the development of newer techniques in prosthetic fitting, alignment, and materials, it is possible to make him walk, run and climb, and even compete in sports with other handicapped individuals quite competently.