Original Article
Prognostic factors of a satisfactory functional result in patients with unilateral amputations of the upper limb above the wrist that use an upper limb prosthesis
Factores pronósticos de un resultado funcional satisfactorio en pacientes con amputaciones unilaterales de extremidad superior por arriba de la muñeca que utilizan próstesis de extremidad superior
A. Dabaghi-Richerand
, F. Haces-García, R. Capdevila-Leonori
Corresponding author
Departamento de Ortopedia Pediátrica, Hospital Shriners para Niños, Ciudad de México, Mexico
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Evaluación de los resultados clínicos del autoinjerto frente al aloinjerto" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 700 "Ancho" => 1800 "Tamanyo" => 105422 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Patient from the autograft group reintervened to relocate a patellar anchor in the immediate postoperative period who evolved with no complications.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "R. Calvo Rodríguez, D. Figueroa Poblete, Z. Anastasiadis Le Roy, F. Etchegaray Bascur, A. Vaisman Burucker, R. 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An analysis of 17 cases" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "333" "paginaFinal" => "342" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Fracturas periprotésicas de fémur sobre hemiartroplastia. Análisis de una serie de 17 casos" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1054 "Ancho" => 1500 "Tamanyo" => 146795 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Case 15. (a) Type B1 fracture; (b) postoperative radiographic monitoring 3 months after the intervention, with delay in consolidation and varus shift in the fracture; (c) radiographic monitoring 3 months after having changed the first plate, which still remains short, with precarious proximal fixation and which has varus shift again.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "M. Suárez-Huerta, A. Roces-Fernández, R. Mencía-Barrio, J.A. Alonso-Barrio, L.R. Ramos-Pascua" "autores" => array:5 [ 0 => array:2 [ "nombre" => "M." "apellidos" => "Suárez-Huerta" ] 1 => array:2 [ "nombre" => "A." "apellidos" => "Roces-Fernández" ] 2 => array:2 [ "nombre" => "R." "apellidos" => "Mencía-Barrio" ] 3 => array:2 [ "nombre" => "J.A." "apellidos" => "Alonso-Barrio" ] 4 => array:2 [ "nombre" => "L.R." 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Dabaghi-Richerand, F. Haces-García, R. Capdevila-Leonori" "autores" => array:3 [ 0 => array:4 [ "nombre" => "A." "apellidos" => "Dabaghi-Richerand" "email" => array:1 [ 0 => "adabaghi@hotmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "F." "apellidos" => "Haces-García" ] 2 => array:2 [ "nombre" => "R." "apellidos" => "Capdevila-Leonori" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Departamento de Ortopedia Pediátrica, Hospital Shriners para Niños, Ciudad de México, Mexico" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Factores pronósticos de un resultado funcional satisfactorio en pacientes con amputaciones unilaterales de extremidad superior por arriba de la muñeca que utilizan próstesis de extremidad superior" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 737 "Ancho" => 1000 "Tamanyo" => 114549 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Patient with transradial amputation using a forearm stump to place a transfemoral prosthesis.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">At present, there is controversy in the medical field regarding the advantages offered by prosthetic adaptation of an upper limb. These are indicated with the aim of providing patients with a mechanical tool allowing them sustained function of the affected limb, which facilitates a better interaction with the physical medium and psychosocial environment. These prostheses promote social acceptance by altering the physical appearance of the patient, and are useful tools for certain types of activities. However, in certain cases, children with longitudinal deficiencies or amputations have a high functional capacity and quality of life regardless of the use of the prosthesis.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">1</span></a> Little is known about the indications and factors related to an adequate functional prognosis and acceptance by patients of the use of these prostheses, so they are frequently indicated with a poor basis regarding the advantages of this type of devices to improve function and overall patient adaptation.</p><p id="par0010" class="elsevierStylePara elsevierViewall">Despite the expectations of both parents and patients about having an instrument that increases functional capacity, frequently both end up not being satisfied with the end result and, despite the motivation given by both physicians and relatives, patients abandon their use at a later age (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">2</span></a></p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">The results in terms of prosthetic adaptation are variable, with a reported rate of rejection around 10–49%.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">3</span></a> Among the most frequent causes of rejection and abandonment of use are: discomfort caused by the harness, inconvenience for the use of certain types of clothing, skin irritation, increased heat production, weight of the prosthesis and cosmetic concerns.<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">4</span></a> Roye et al. pointed out that children with chronic conditions had an adaptation response conditioned by a lack of knowledge of a different health condition.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">5</span></a> The study conducted by Postema et al. confirmed what the literature has historically proposed regarding upper limb prostheses, which are frequently limited to offering the patient a functional gain. It is for this reason that patients eventually reject them.<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">6</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">This study aims to evaluate the prognostic factors for an adequate prosthetic adaptation in the upper limbs and the variables conditioning a satisfactory functional result. This should provide a better understanding regarding which patients will benefit from using an upper limb prosthesis.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Material and method</span><p id="par0025" class="elsevierStylePara elsevierViewall">This was a cross-sectional study with patients from Shriners Hospital for Children (Mexico D. F.), who used body activation upper limb prostheses during the period between January 1991 and June 2008. All the patients were amputated at least at the level of proximal forearm.</p><p id="par0030" class="elsevierStylePara elsevierViewall">All patients underwent a psychological evaluation, as well as preprosthetic training for 2 months and prosthetic for a mean period of 4 months at the Department of Occupational Therapy of Shriners Hospital for Children (Mexico D. F.) once the prosthesis had been delivered. Use of the prosthesis was defined as usage for at least 2<span class="elsevierStyleHsp" style=""></span>h/day. The <span class="elsevierStyleItalic">Disability arm shoulder hand</span> (DASH) scale was used to assess the function of the upper limb prosthesis. This scale evaluates the level of disability to carry out certain activities perceived by patients.<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">7</span></a> The independent variables analysed to determine the functional prognosis were: level of amputation, age at the start of using the prosthesis, aetiology leading to the use of the prosthesis, number of hours of usage per day.</p><p id="par0035" class="elsevierStylePara elsevierViewall">The clinical history was reviewed and all patients, or a direct relative, were interviewed to determine the independent variables and application of the DASH questionnaire.</p><p id="par0040" class="elsevierStylePara elsevierViewall">A favorable functional result was determined as those patients with a DASH score <40%.</p><p id="par0045" class="elsevierStylePara elsevierViewall">A sample of 67 patients was obtained, of which 8 were excluded due to a poor use of the prosthesis (<2<span class="elsevierStyleHsp" style=""></span>h/day), 2 were excluded due to rejection of usage for over 6 months, and 8 could not be located to apply the DASH questionnaire, so the final study sample was comprised by 49 patients.</p><p id="par0050" class="elsevierStylePara elsevierViewall">An analysis of the DASH scale was conducted with the independent variables through a Fischer exact test for all variables. The level of statistical significance was established at <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>.05, with a 95% confidence interval (CI).</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Results</span><p id="par0055" class="elsevierStylePara elsevierViewall">Out the 49 patients, 37 (75.5%) had a proximal forearm stump, 5 (10.2%) a transhumeral stump and 7 (14.2%) were disjointed at the shoulder. A total of 36 (73.4%) had a congenital aetiology and 13 (16.6%) had a traumatic aetiology. The mean age of the sample was 11.5 years, with a minimum age of 3 and a maximum age of 18 years.</p><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Level of amputation</span><p id="par0060" class="elsevierStylePara elsevierViewall">A total of 37 patients had a level of amputation under the elbow (UE) and 12 above the elbow (AE). There were 25 good results among the UE group and 7 among the AE group, with a value of <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>.7287. The level of amputation was found not to be significant in predicting a functional result.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Congenital vs traumatic</span><p id="par0065" class="elsevierStylePara elsevierViewall">Good results were obtained in 27 congenital cases and 5 traumatic cases, whilst poor results were obtained in 9 congenital cases and 8 traumatic cases, with a value of <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>.0383. The level of function presented by patients according to their aetiology was statistically significant (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> and <a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>).</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Start of usage</span><p id="par0070" class="elsevierStylePara elsevierViewall">Regarding the 49 patients analysed, it was observed that, out of those who started using the prosthesis before the age of 6 years, 27 had a good result and only 7 had a poor result. In addition, out of those who used the prosthesis after the age of 6 years, only 5 had a good result, whilst 10 had a poor result. These results were statistically significant, with a value of <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>.0031.</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Hours of use per day</span><p id="par0075" class="elsevierStylePara elsevierViewall">It was observed that, out of the patients who used the prosthesis for more than 6<span class="elsevierStyleHsp" style=""></span>h/day, 26 had a good result and only 3 had a poor result. It was also observed that, out of those who used their prosthesis for less than 6<span class="elsevierStyleHsp" style=""></span>h/day, only 6 had a good functional result and 14 had a poor result, with a value of <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>.0001.</p></span></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Discussion</span><p id="par0080" class="elsevierStylePara elsevierViewall">Although it is true that prostheses contribute to social acceptance and certain special activities, there is still considerable controversy regarding the benefits of adapting an upper limb prosthesis in children, particularly in unilateral amputations below the elbow, since the levels of function and quality of life observed are very close to normal. This questions the practice of routinely adapting such prostheses.<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">8</span></a></p><p id="par0085" class="elsevierStylePara elsevierViewall">This study managed to establish the prognostic variables to help determine a satisfactory functional result with greater precision in proximal forearm and transhumeral amputations and shoulder disjoints, as well as to predict which patients could be associated to a higher rate of rejection.</p><p id="par0090" class="elsevierStylePara elsevierViewall">The study by Lerman et al. found an inverse relationship to the level of amputation among groups with high functional demands. However, the general group (activities of daily life) did not show any difference in terms of the level of amputation,<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">9</span></a> which is correlated with the findings in our study, where no statistically significant differences were found either between the functional results of the 2 groups, despite our hypothesis that the elbow joint provided patients with a functional advantage to place the terminal device in a better position, as well as increase in activation speed, which would facilitate adaptation and prosthetic usage.</p><p id="par0095" class="elsevierStylePara elsevierViewall">Regarding the age and aetiology leading to the use of a prosthesis, a significant difference was found in the functional result between the 2 groups, with a better function among patients who used the prosthesis because of a congenital aetiology and those who had a prosthesis adapted before the age of 6 years. These findings were correlated with how each patient perceived the environment prior to the use of the prosthesis. We believe that adapting a prosthesis before the age of 6 years allows patients to discover that the use of the prosthesis is beneficial for special activities at the same time as they develop<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">1,10</span></a> and allows them to adapt the prosthesis in a better way, making its use indispensable for both common and special activities. These findings are correlated with those reported by Scotland and Galway,<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">3</span></a> as well as Brooks and Shaperman,<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">11</span></a> who found a higher rate of rejection among patients who started to use the prosthesis after 2 years.</p><p id="par0100" class="elsevierStylePara elsevierViewall">Regarding the aetiology, we believe that it is related to the fact that children with congenital deficiencies do not have a sense of loss,<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">12</span></a> thus making it easier to adapt a mechanism which allows them to increase their functional level. That is not the case in patients with traumatic amputations, who had a prior functional level, and are now introduced to a mechanism affecting the performance of previously known daily activities with associated activation mechanisms, thus hindering adaptation and the attainment of a level of function close to normality.</p><p id="par0105" class="elsevierStylePara elsevierViewall">A significant level of association was identified regarding the number of hours which the patient used the prosthesis for with a satisfactory functional result: those patients who used the prosthesis for over 6<span class="elsevierStyleHsp" style=""></span>h presented a functional level close to normality. We believe that this is related to an adequate functional adaptation which leads to individuals using the prosthesis for a longer time, since it increases the functional level and promotes social integration and acceptance by peers.<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">13</span></a></p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Conclusions</span><p id="par0110" class="elsevierStylePara elsevierViewall">The use of upper limb prostheses and their acceptance by patients has been and continues to be a controversial topic, particularly in children, in whom the rate of rejection is high. There have been numerous studies and speculations regarding which patients will benefit from their use, since a large proportion of patients do not obtain functional gains through the use of a prosthesis. Although it is true that upper limb prostheses do not only generate a functional gain, but also promote social adaptation and feeling of normality, nevertheless, a large proportion of children and parents report discouraging functional results.</p><p id="par0115" class="elsevierStylePara elsevierViewall">The present study was able to establish factors that may guide physicians and relatives when making a decision according to their needs and predict a prognosis regarding the functional result of using an upper limb prosthesis. In this study we have been able to observe greater functional gains among patients with congenital deficiencies, in whom introduction and psychological management took place before the age of 6. We also observed better function among those patients who used the prosthesis for a longer period per day, leading to a lower rate of rejection.</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Level of evidence</span><p id="par0120" class="elsevierStylePara elsevierViewall">Level of evidence <span class="elsevierStyleSmallCaps">IV</span>.</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Ethical responsibilities</span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Protection of people and animals</span><p id="par0125" class="elsevierStylePara elsevierViewall">The authors declare that this investigation did not require experiments on humans or animals.</p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Confidentiality of data</span><p id="par0130" class="elsevierStylePara elsevierViewall">The authors declare that they have followed the protocols of their workplace on the publication of patient data.</p></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Right to privacy and informed consent</span><p id="par0135" class="elsevierStylePara elsevierViewall">The authors declare that this work does not reflect any patient data.</p></span></span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0135">Conflict of interests</span><p id="par0140" class="elsevierStylePara elsevierViewall">The authors have no conflict of interests to declare.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:13 [ 0 => array:3 [ "identificador" => "xres539601" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Purpose" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Materials and methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Discussion" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec559170" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres539600" "titulo" => "Resumen" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Objetivo" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Material y método" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Discusión" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec559171" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Material and method" ] 6 => array:3 [ "identificador" => "sec0015" "titulo" => "Results" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "sec0020" "titulo" => "Level of amputation" ] 1 => array:2 [ "identificador" => "sec0025" "titulo" => "Congenital vs traumatic" ] 2 => array:2 [ "identificador" => "sec0030" "titulo" => "Start of usage" ] 3 => array:2 [ "identificador" => "sec0035" "titulo" => "Hours of use per day" ] ] ] 7 => array:2 [ "identificador" => "sec0040" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0045" "titulo" => "Conclusions" ] 9 => array:2 [ "identificador" => "sec0050" "titulo" => "Level of evidence" ] 10 => array:3 [ "identificador" => "sec0055" "titulo" => "Ethical responsibilities" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0060" "titulo" => "Protection of people and animals" ] 1 => array:2 [ "identificador" => "sec0065" "titulo" => "Confidentiality of data" ] 2 => array:2 [ "identificador" => "sec0070" "titulo" => "Right to privacy and informed consent" ] ] ] 11 => array:2 [ "identificador" => "sec0075" "titulo" => "Conflict of interests" ] 12 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2014-09-24" "fechaAceptado" => "2014-11-04" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec559170" "palabras" => array:3 [ 0 => "Amputation upper extremity" 1 => "Prosthetics" 2 => "Functional outcome" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec559171" "palabras" => array:3 [ 0 => "Amputación de miembro torácico" 1 => "Prótesis" 2 => "Resultado funcional" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Purpose</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">The purpose of this study is to determine the prognostic factors of a satisfactory functional outcome in patients using upper extremity prosthetics with a proximal third forearm stump, and above, level of amputation.</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Materials and methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">All patients with longitudinal deficiencies and traumatic amputations of upper extremity with a level of amputation of proximal third forearm and above were included. A total of 49 patients with unilateral upper extremity amputations that had used the prosthetic for a minimum of 2 years were included in the protocol. The Disability arm shoulder hand (DASH) scale was used to determine a good result with a cut-off of less than 40%. The independent variables were the level of amputation, the aetiology for its use, initial age of use and number of hours/day using the prosthesis.</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">It was found that patients with a congenital aetiology and those that started using the prosthetic before 6 years of age had better functional results.</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Discussion</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">It was found that when adapting a patient with an upper extremity prosthetic, which has a high rejection rate of up to 49%, better functional outcomes are found in those who started using it before 6 years of age, and preferably because of a congenital aetiology. It was also found that the number of hours/day strongly correlates with a favourable functional outcome.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Purpose" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Materials and methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Discussion" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Objetivo</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">El objetivo de este artículo es evaluar los factores pronósticos para una adecuada adaptación protésica de extremidad superior y qué variables condicionan un resultado funcional satisfactorio en pacientes con una amputación por encima del tercio proximal del antebrazo.</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Material y método</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Se incluyó en el estudio a 49 pacientes con deficiencias longitudinales o amputaciones traumáticas de extremidad superior de antebrazo proximal hasta desarticulación de hombro, con un tiempo mínimo de utilización de la prótesis de 2 años. Se utilizó la escala de <span class="elsevierStyleItalic">Disability arm shoulder hand</span> (DASH), tomando como un resultado satisfactorio un valor de menos de 40%. Las variables independientes fueron etiología del uso, nivel de la amputación, inicio de uso y h/día de uso.</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Se consideró de buen pronóstico a aquellos pacientes con una etiología congénita y cuando el inicio del uso de la prótesis era antes de los 6 años, mostrando una diferencia significativa entre los grupos.</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Discusión</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Se encontró que la etiología congénita es de buen pronóstico, al igual que el caso de aquellos que utilizan la prótesis más de 6<span class="elsevierStyleHsp" style=""></span>h/día. Por medio de este trabajo se pudieron demostrar mejores resultados funcionales en los pacientes a los que se les adapta una prótesis de extremidad superior antes de los 6 años y preferentemente por una etiología congénita. También se encontró que el número de horas de uso al día correlaciona con un resultado funcional favorable.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Objetivo" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Material y método" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Discusión" ] ] ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Dabaghi-Richerand A, Haces-García F, Capdevila-Leonori R. Factores pronósticos de un resultado funcional satisfactorio en pacientes con amputaciones unilaterales de extremidad superior por arriba de la muñeca que utilizan próstesis de extremidad superior. Rev Esp Cir Ortop Traumatol. 2015;59:343–347.</p>" ] ] "multimedia" => array:3 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 737 "Ancho" => 1000 "Tamanyo" => 114549 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Patient with transradial amputation using a forearm stump to place a transfemoral prosthesis.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1267 "Ancho" => 1614 "Tamanyo" => 109705 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Results.</p>" ] ] 2 => array:7 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col">Result \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Level of amputation</th><th class="td" title="table-head " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Aetiology</th><th class="td" title="table-head " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Start of use</th><th class="td" title="table-head " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Hours/day of usage</th></tr><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Below the elbow \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Above the elbow \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Congenital \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Traumatic \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black"><6 years \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">>6 years \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black"><6<span class="elsevierStyleHsp" style=""></span>h \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">>6<span class="elsevierStyleHsp" style=""></span>h \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Good \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">25 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">27 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">27 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">26 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Poor \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">12 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">10 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">14 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab867135.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Functional results according to DASH scale score.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:13 [ 0 => array:3 [ "identificador" => "bib0070" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Impact of prostheses on function and quality of life for children with unilateral congential below-the-elbow deficiency" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => 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Galway" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Bone Joint Surg Br" "fecha" => "1983" "volumen" => "65" "paginaInicial" => "346" "paginaFinal" => "349" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/6841409" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0085" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Reasons for prosthetic rejection by children with unilateral congenital transverse forearm total deficiency" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "L.V. Wagner" 1 => "A.M. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 October | 22 | 1 | 23 |
| 2024 September | 40 | 4 | 44 |
| 2024 August | 26 | 4 | 30 |
| 2024 July | 33 | 2 | 35 |
| 2024 June | 56 | 2 | 58 |
| 2024 May | 52 | 12 | 64 |
| 2024 April | 32 | 10 | 42 |
| 2024 March | 43 | 4 | 47 |
| 2024 February | 47 | 11 | 58 |
| 2024 January | 95 | 20 | 115 |
| 2023 December | 77 | 8 | 85 |
| 2023 November | 104 | 18 | 122 |
| 2023 October | 103 | 9 | 112 |
| 2023 September | 42 | 3 | 45 |
| 2023 August | 41 | 3 | 44 |
| 2023 July | 62 | 6 | 68 |
| 2023 June | 55 | 1 | 56 |
| 2023 May | 89 | 12 | 101 |
| 2023 April | 77 | 3 | 80 |
| 2023 March | 52 | 7 | 59 |
| 2023 February | 41 | 3 | 44 |
| 2023 January | 52 | 8 | 60 |
| 2022 December | 58 | 5 | 63 |
| 2022 November | 35 | 7 | 42 |
| 2022 October | 85 | 7 | 92 |
| 2022 September | 87 | 9 | 96 |
| 2022 August | 46 | 7 | 53 |
| 2022 July | 39 | 9 | 48 |
| 2022 June | 27 | 12 | 39 |
| 2022 May | 46 | 12 | 58 |
| 2022 April | 27 | 9 | 36 |
| 2022 March | 28 | 4 | 32 |
| 2022 February | 41 | 5 | 46 |
| 2022 January | 70 | 14 | 84 |
| 2021 December | 31 | 7 | 38 |
| 2021 November | 30 | 7 | 37 |
| 2021 October | 44 | 8 | 52 |
| 2021 September | 34 | 8 | 42 |
| 2021 August | 30 | 3 | 33 |
| 2021 July | 15 | 5 | 20 |
| 2021 June | 24 | 11 | 35 |
| 2021 May | 17 | 4 | 21 |
| 2021 April | 56 | 20 | 76 |
| 2021 March | 21 | 8 | 29 |
| 2021 February | 15 | 8 | 23 |
| 2021 January | 10 | 3 | 13 |
| 2018 February | 9 | 0 | 9 |
| 2018 January | 6 | 1 | 7 |
| 2017 December | 11 | 1 | 12 |
| 2017 November | 6 | 2 | 8 |
| 2017 October | 11 | 0 | 11 |
| 2017 September | 14 | 1 | 15 |
| 2016 December | 0 | 2 | 2 |
| 2016 November | 0 | 2 | 2 |
| 2016 October | 0 | 3 | 3 |
| 2016 June | 0 | 1 | 1 |
| 2016 May | 0 | 4 | 4 |
| 2016 February | 0 | 2 | 2 |
| 2015 October | 0 | 1 | 1 |
| 2015 August | 0 | 1 | 1 |
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