Poster 130 Benefits of Microprocessor Controlled Prosthetic Knee Joints to Limited Community...

PM&R Vol. 6, Iss. 9S, 2014 S229

Poster 129Sacral Insufficiency Fracture in a Patient withOsteogenesis Imperfecta: A Case Report.Laura Davids, MD (Stony Brook University MedicalCenter, Stony Brook, NY, United States);Peter Lascarides, DO; Susan M. Stickevers, MD.

Disclosures: L. Davids, No Disclosures: I Have No RelevantFinancial Relationships to Disclose.Case Description: A 62-year-old man with history of osteo-genesis imperfecta (OI), alcoholism, and thirty pathological frac-tures complained of hip and buttock pain after falling. His pain wasdescribed as sharp and 10/10 in severity. On examination, he hadblue sclera, and he appeared older than stated age. The patient hadright hip and buttock pain upon palpation, with a small hematomaand abrasion. He had normal strength in all four extremities. Hipand pelvis radiographs were unremarkable. Spine radiographsrevealed old lumbar compression fractures. The patient’s pain wasintractable despite conservative management so a bone scan wasordered. It revealed intense radioisotope uptake in the lowersacroiliac joints bilaterally as well as in the lower sacrum,compatible with insufficiency fracture.Setting: Tertiary care hospital.Results or Clinical Course: This patient with OI suffereda fall and was noted to have negative standard radiographicstudies. He was later found to have a sacral insufficiencyfracture on bone scan. A tilt in space electric wheelchair withcustom seating system, ambulation with a walker with weightbearing as tolerated, acupuncture and hot pack application wererecommended. He was safely discharged home and stated thathe is functioning well with minimal pain upon outpatientfollow up.Discussion: The most common underlying disease in insuffi-ciency fractures is osteoporosis, but other risk factors such asrheumatoid arthritis, corticosteroid therapy, fibrous dysplasia,Paget’s disease, and OI, often underlie the diagnosis. Ahigh suspicion for insufficiency fracture should be maintainedwith any patient with even minor trauma, pain and a historyof OI.Conclusions: This case report underscores the importance ofobtaining a bone scan in a patient with osteoporosis or other riskfactors to rule out sacral insufficiency fracture, even in the presenceof negative radiographs.

Poster 130Benefits of Microprocessor Controlled ProstheticKnee Joints to Limited Community Ambulators:A Systematic Review.Andreas Kannenberg, MD (Germany), PhD (Otto BockHealthCare LP, Minneapolis, MN, United States);Eva Pröbsting, CPO, Dipl.-Ing.;Britta Zacharias, CPO, Dipl-Ing.

Disclosures: A. Kannenberg, Employment (fulltime), Otto BockHealthCare LP.Objective: To analyze the scientific literature on the effects ofmicroprocessor controlled prosthetic knee joints (MPKs) in limitedcommunity ambulators (Medicare Functional Classification Level 2[MFCL-2]) with a unilateral transfemoral amputation.Design: Literature database search and systematic review.

Setting: N/AParticipants: N/AInterventions: Systematic search of publications in the litera-ture databases Medline, EMBASE, PsychInfo, DARE, Cirrie,CINAHL, Cochrane Library, OTseeker, PEDro, and RECALLegacy with terms related to MPKs and individuals witha unilateral transfemoral amputation and MFCL-2 mobility grade.Assessment of methodological quality and risk of bias usinga rating scale developed for a Cochrane review of prostheticankle-foot mechanisms.Main Outcome Measures: Outcome measures related tosafety of prosthesis use, performance-based function and mobility,and perceived function and satisfaction.Results or Clinical Course: 6 publications on 4 clinicalstudies with MPK use in 57 subjects with a unilateral trans-femoral amputation and MFCL-2 mobility grade were identified.Methodological quality was rated moderate in 4 and low in 2papers. Safety outcomes demonstrated a significant reduction inthe number (up to 80%) and frequency of falls as well assignificant improvements in parameters indicating the risk offalling, such as the timed up and go test (TUG, 28%) and theactivities-specific balance confidence scale (ABC, 26%), whenusing a MPK as compared to non-MPKs. 55% of the perfor-mance-based outcome measures assessed showed a significantimprovement of function with the MPK. About half of theindividuals were able to improve their overall mobility toMFCL-3. The majority of patients preferred the MPKs which ismost likely related to the perceived increase in safety of pros-thesis use.Conclusions: Limited community ambulators with a unilateraltransfemoral amputation may benefit from using an MPK insafety, function, and overall mobility. Individual trial fittings maybe used to determine whether or not a subject benefits fromusing a MPK.

Poster 131An Orthotronic Mobility System Improves PerceivedWalking Capabilities in Traditional Leg OrthosisUsers.Andreas Kannenberg, MD (Germany), PhD (Otto BockHealthCare LP, Minneapolis, MN, United States);Eva Pröbsting, CPO, Dipl.-Ing.

Disclosures: A. Kannenberg: Employment (full-time), Otto BockHealthCare LP.Objective: To study if an orthotronic mobility system (OBS)with microprocessor hydraulic stance and swing phase controlallowing for controlled knee flexion during weight bearingimproves walking capabilities in patients with pareses/paralysisof lower limb muscles dependent on traditional lockedknee ankle foot orthoses (KAFO) or stance control orthoses(SCO).Design: Comparative within-subject study.Setting: Survey administered at baseline for existing device andafter 3 months use of the interventional device in several orthoticclinics.Participants: 13 subjects with various neurologic conditionscausing pareses/paralysis of lower limb muscles using traditionalKAFOs (5 locked KAFOs, 8 SCOs).