Disclosures: Kevin T. Ozment, MD: No financial relationships or conflicts of interest

Case Description: The patient suffered massive crush injuries requiring emergent hemicorporectomy at L4/L5 level, bilateral nephrostomy tubes, end colostomy, right elbow disarticulation leading to transhumeral amputation, and intra-abdominal abscesses necessitating IR drain placement. His core stability and sitting tolerance improved despite external devices that complicated skin integrity. He progressed to using a power wheelchair with bucket prosthesis, and displayed improvements in core stability and sitting tolerance. Initially he was fitted with a passive arm prosthesis to use for transfers and object stabilization. Phantom limb pain was difficult to control and functionally limiting. By discharge, the patient had significantly reduced pain through specialized pain therapies in conjunction with duloxetine, pregabalin, marinol, and opioids.

Setting: Inpatient Rehabilitation Facility

Patient: An 18 year old male status post hemicorporectomy and right transhumeral amputation. Assessment/

Results: After 1 month of comprehensive rehabilitation he met nearly all long term goals. He improved to supervision and modified independence for transfers and locomotion respectively. His functional rehabilitation and prosthetic fitting was challenged by medical complexity and multiple drains. For his hemicorporectomy, preliminary bucket prosthesis was created with thermomoldable plastic and pelite liner with plans for a definitive bucket with laminated external shell and inner air bladder liner to allow for prolonged sitting. For his transhumeral amputation, he was fitted for a passive prosthesis with plans for externally powered prosthesis to be fitted as an outpatient.

Discussion: Hemicorporectomy is a very rare diagnosis. To our knowledge, there are no prior reported cases of a patient with both hemicorporectomy and upper limb amputation. The addition of his transhumeral amputation, traumatic psychological implications of his injury, and severe phantom limb pain further convoluted his amputee rehabilitation needs.

Conclusion: Rehabilitation and prosthetic design following a hemicorporectomy is ripe with challenges. A coordinated interdisciplinary approach between the Physiatrist, prosthetics, and therapy is essential to improving the function of these patients.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/rehabilitation-following-a-hemicorporectomy-and-right-elbow-disarticulation-a-case-report/