Disclosures: Daniel K. Hussey, MD: No financial relationships or conflicts of interest

Case Diagnosis: 33-year-old female with 60% total-body-surface-area partial-full thickness burns requiring numerous surgeries resulting in quadrilateral extremity amputations.

Case Description: As a sequelae of the patient’s extensive burns and surgeries, the patient had bilateral below the elbow, right knee disarticulation and left above knee amputations. The patient had been treated at a long-term acute care hospital prior to transfer to an inpatient rehabilitation facility for burn rehabilitation for 4 months. Despite rehabilitation efforts, she had developed bilateral elbow contractures limited to 90-degree right elbow flexion (EF), -40-degree right elbow extension (EE), 85-degree left EF, -35-degree left EE. Her elbow contractures limited effective use of a below elbow prostheses. Her contractures were initially managed with sustained static stretching and then serial casting with minimal change in range of motion (ROM). She was subsequently fitted with trial custom “wingspan” weighted forearm pilon prostheses without terminal devices, increasing force for passive stretching by using a 3 lever “forearm.” Outside of dedicated OT therapy, the patient donned these protheses to continue sustained static stretching.

Setting: Acute rehabilitation hospitalAssessment/

Results: After 5 weeks, the patient had significantly improved ROM at the elbow: 25-degree improvement for right EF, 5-degree improvement for right EE, 5-degree improvement for left EF, 10-degree improvement for left EE. With her additional elbow ROM, she began using a universal cuff on her distal R residual limb for self-feeding and grooming tasks including brushing teeth, doing makeup, combing and shampooing hair.

Discussion: This case demonstrates the use of type 3 lever “forearm” wingspan temporary prostheses to improve the bilateral elbow ROM in a patient with refractory burn-related contractures and allow for improved upper limb function and fitting of below elbow prostheses.

Conclusion: Temporary wingspan prostheses used by OT and staff may be useful tools to improve elbow contractures unresponsive to sustained static stretching and serial casting.

Level of Evidence: Level V

« Back to AAPM&R Annual Assembly 2021

PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/when-is-a-lever-arm-a-lever-forearm-custom-length-temporary-wingspan-prostheses-reduce-resistant-elbow-contractures-in-an-amputee-patient-with-burns-a-case-report/