Disclosures: Boss Povieng, MD: No financial relationships or conflicts of interest

Case Diagnosis: 24-year-old male with bilateral Proximal Femoral Focal Deficiency (PFFD)

Case Description: The patient has a left tapered transfemoral amputation and short right transfemoral with distal end intact foot. The patient presented to the clinic wearing dated prostheses with chronic sores, callusing, unstable gait mechanics and chronic shoulder pain from reliance on crutches. The patient is a high level active amputee and was recommended for K4 componentry with microprocessor knees (MPK).

Setting: Tertiary care academic hospitalAssessment/

Results: An endoskeletal construction design was pursued to decrease energy consumption, walking effort and improve prosthetic control. For the left side a more traditional total contact ischial containment socket with seal in suspension was designed. However, on the right, a unique design using the foot as an anchor for anatomic suspension with careful details to ensure proper loading and prevention of skin breakdown was done. MPK was used for flexion stumble recovery, fall prevention, increased prosthesis weight bearing and enhanced gait mechanics to reduce dependence on crutches. The patient completed 28 physical therapy sessions and was able to meet goals to ambulate independently for 10 minutes with limited assistance and to perform transfers with equal weight bearing through each lower extremity.

Discussion: PFFD is a rare condition that affects 0.11-0.2 of 10,000 births with bilateral involvement comprising only 10-15% of cases. PFFD results in gait abnormalities from limb-length discrepancy, joint instability and muscle dysfunction. Bilateral PFFD prosthetic fitting is not well known in the literature. This report summarizes a successful approach to the challenging prosthetic fitting of a patient with bilateral PFFD requiring two different approaches for fitting.

Conclusion: Management of prosthetic fitting for bilateral PFFD with bilateral amputation with a novel comprehensive approach can produce excellent functional outcomes.

Level of Evidence: Level IV

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/an-approach-to-the-challenging-prosthetic-fitting-of-a-patient-with-bilateral-proximal-femoral-focal-deficiency-a-case-report/