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Patellar Tendon Weight-Bearing AFO in a Complicated Female Case with

Comminuted Fracture Tibia as a Result of Conflict in Gaza

Mazen Hamam 1, Heba Bashir2,

1 Artificial Limbs and Polio Center, Prosthetist and Orthotist, Gaza 2 Artificial Limbs and Polio Center,

Prosthetist and Orthotist, Gaza.

BACKGROUND
A 44 years-old obese female was injured as a result of shelling in 2014, had comminuted fracture tibia
distal third, refused amputation, multiple surgeries were done with Tibial Fibularization the last, has
been in wheelchair for 4-years, presented with 8cm shortening, deformed leg, partial loss of calf-
muscle, ankle arthrodesis in 40° planter-flexion, fluctuated leg circumference and poor general
endurance. The prescription was to offload her weight from the affected area.

AIM
Protect the affected area by fitting her with offloading device as well as to restore walking in order to
improve her quality of life.

METHOD
Patellar tendon weight bearing Ankle Foot Orthosis (AFO) was done by using polypropylene for
posterior shell, thermolyne for anterior shell, covered by leather, lacer to allow for easily adjustment to
accommodate her fluctuating circumference. It is to make suspension in such a way to allow self-
aligning within the frame of the orthosis. 8 cm compensation was added by using pedilen Rigid foam
and a rocker shoes was also provided to allow easily roll over. She was also referred for Gait-training
by physiotherapy team.

RESULTS
She was fitted with the device with proper alignment between leg and foot. Comfortability as well as
off-loading were achieved. She managed to confidently stand and restore her ambulation which she
lost since the last 4 years. She is able now to walk independently with much better general endurance
obtained. Happily to mention that her quality of life is improved.

DISCUSSION AND CONCLUSION

Despite the complicated presentation of the mentioned case which wasn’t the best surgical solution to
maintain the complicated leg, however patients preferences is the limiting factor for such decisions
and we should respect and be flexible with the complicated context in the Gaza strip. Follow-up of
such complicated case should be continuous to better tackle any changes.
Each patient is unique with his/her presentation, and we should adapt ourselves accordingly.

REFERENCES
J. Martin Carlson, CPO; Journal of Prosthetics and orthotics, volume 4, Number 1,pp .41-44

ACKNOWLEDGEMENTS
Saeda El Barawi, Physiotherapist Field Officer, International committee of the Red Cross