Case Report: Implementation of Hand Prosthosis as Part of Rehabilitation Team Effort Secondary to Blast Injury for US Iraq-War Veteran

Abstract

In Brief In October 2005, a 23-year-old Operation Iraqi Freedom (OIF) Army Sergeant sustained blast injuries from a roadside bomb while riding in a vehicle. Injuries included full-thickness thermal burns to 45% of his body, brain trauma, compartment syndrome to both lower limbs and abdomen, multiple strokes, bilateral shoulder and arm contractures, and amputation of the left thumb. Treatment of the patient necessitated the combined expertise of medical rehabilitation teams. Patient treated in the field and at Iraq-based Military Hospital was then transferred to Germany and arrived at Brooke Army Hospital in the United States within a 5-day postinjury period. Subsequently, the patient was transferred to the James A. Haley Veterans Hospital in Tampa, Florida, and, after initial stabilization, received treatment at the Tampa General Regional Burn Center. The patient remained an inpatient on the James A. Haley Veterans Hospital Polytrauma Unit until his discharge. Management of care at the VA included surgery, occupational therapy, physical therapy, and prosthetic treatment. The patient suffers from paralysis and contractures of bilateral upper limbs, bilateral foot drop/paralysis requiring the use of a power chair for long-distance ambulation. The patient has significantly limited use of his hands, but maintains function of the thenar eminence of the left hand. To restore hand functionality, patient was fitted with a hybrid orthosis-prosthesis consisting of a wrist-hand orthosis splint and a child’s myoelectric hand. This case demonstrates the effectiveness of the rehabilitation team involved in complex cases of patient care and highlights the use of a battery-operated myoelectric device to establish added independence and a sense of self-reliance by successfully restoring functional grip and prehension of a paralyzed and partially amputated hand. After sustaining blast injuries from a roadside bomb in Iraq, a US Army veteran suffers from paralysis and contractures of both upper limbs and bilateral foot drop/paralysis requiring the use of a power chair for long-distance ambulation. The patient has significantly limited use of his hands, but maintains function of the thenar eminence of the left hand. To restore hand functionality, the patient was fitted with a hybrid orthosis-prosthesis consisting of a wrist-hand orthosis splint and a child's myoelectric hand. The case demonstrates the effectiveness of the rehabilitation team involved in complex cases and highlights the use of a battery- operated myoelectric device to successfully restore functional grip and prehension to a paralyzed and partially amputated hand.