title: Attachment of upper arm prostheses with a subcutaneous osseointegrated implant in transhumeral amputees.
abstract: BACKGROUND
  The stump-socket interface is of utmost importance for prosthetic function in transhumeral amputees. Stability of this connection may be improved using a newly designed subcutaneous implant.
  
  
  OBJECTIVE
  The purpose was to determine the effect of the implant together with customized socket designs on the range of motion of the shoulder and the prosthetic function compared to conventional fitting.
  
  
  METHODS
  Case series.
  
  
  METHODS
  The range of motion was measured with scaled metrics and the prosthetic function evaluated with the Southampton Hand Assessment Procedure and the Box and Block Test. Maximal loading was measured in straight and 90° flexion of the elbow.
  
  
  RESULTS
  The restriction of range of motion after conventional fitting was decreased from 42.55% ± 6.56% to 9.23% ± 14.89% in Patient I and from 62.18% ± 15.19% to 2.51% ± 2.49% in Patient II using the implant with customized sockets compared to range of motion without prosthesis. Both patients showed improved prosthetic function with the new system compared to conventional fitting.
  
  
  CONCLUSIONS
  The presented subcutaneous humeral implant, together with customized socket designs without straps and harnesses to the contralateral shoulder, can maintain almost complete range of motion of the shoulder. This resulted in improved prosthetic function and comfort for the patient without constant risk of infection. Clinical relevance Discomfort and limited prosthetic function are the main reasons for abandonment especially in transhumeral amputees. Shoulder straps and harnesses within conventional socket designs may not only lead to pain and skin irritations at the contralateral shoulder but also limit the range of motion of the shoulder joint and therefore prosthetic function.
authors.affiliation: 1 Division of Plastic and Reconstructive Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria.|2 Christian Doppler Laboratory for Restoration of Extremity Function,Medical University of Vienna, Austria.
authors.forename: Stefan
authors.initials: S
authors.lastname: Salminger
authors.affiliation: 3 Otto Bock Health Care Products GmbH, Vienna, Austria.
authors.forename: Andreas
authors.initials: A
authors.lastname: Gradischar
authors.affiliation: 3 Otto Bock Health Care Products GmbH, Vienna, Austria.
authors.forename: Richard
authors.initials: R
authors.lastname: Skiera
authors.affiliation: 2 Christian Doppler Laboratory for Restoration of Extremity Function,Medical University of Vienna, Austria.|4 Department of Plastic Surgery, Southmead Hospital, North Bristol NHS Trust, UK.
authors.forename: Aidan D
authors.initials: AD
authors.lastname: Roche
authors.affiliation: 2 Christian Doppler Laboratory for Restoration of Extremity Function,Medical University of Vienna, Austria.|5 Universtity of Applied Sciences FH Campus Wien, Vienna, Austria.|6 Department of Physical Medicine and Rehabilitation, Medical University of Vienna, Austria.
authors.forename: Agnes
authors.initials: A
authors.lastname: Sturma
authors.affiliation: 3 Otto Bock Health Care Products GmbH, Vienna, Austria.
authors.forename: Christian
authors.initials: C
authors.lastname: Hofer
authors.affiliation: 1 Division of Plastic and Reconstructive Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria.|2 Christian Doppler Laboratory for Restoration of Extremity Function,Medical University of Vienna, Austria.
authors.forename: Oskar C
authors.initials: OC
authors.lastname: Aszmann
mesh_terms: D000328:Adult; D000672:Amputation Stumps / Q000503:physiopathology / Q000601:surgery; D001186:Artificial Limbs; D006801:Humans; D016268:Internal Fixators; D008297:Male; D008875:Middle Aged; D009043:Motor Activity / Q000502:physiology; D016348:Osseointegration; D011474:Prosthesis Design; D019919:Prosthesis Implantation; D016059:Range of Motion, Articular / Q000502:physiology; D034941:Upper Extremity; D016474:Weight-Bearing / Q000502:physiology
keywords: Biomechanics; implant; osseointegration; prosthetic interface mechanics; prosthetics; rehabilitation; rehabilitation of amputees; transhumeral amputation