Nichola Fosler, a partner in our Personal Injury department, hosted a webinar entitled “Integrated management of amputees: treatment and outcomes” on 20 January 2021. The webinar included presentations by Jon Kendrew, consultant orthopaedic surgeon, Demetrius Evriviades, consultant plastic and reconstructive surgeon, Alan McDougall, prosthetist and Holly King, physiotherapist, who form part of the Birmingham Amputee clinic (BAC) in partnership with HK Physiotherapy and ProActive Prosthetics.
The BAC team covers the fields of orthopaedic surgery, plastic surgery, psychiatry, physiotherapy and prosthetics. The team discussed its holistic multi-disciplinary approach to maximising patient function by minimising pain in amputees who experience neurogenic and musculoskeletal pain.
The webinar was well attended by a range of delegates including case managers, clinicians, claimant solicitors, defendant solicitors and insurers.
Alan talked about his role as a prosthetist. He discussed the importance of good socket fit to minimise tissue damage and the right componentry to promote shock absorption. He also highlighted the limitations on prosthetics when dealing with neuroma pain, poorly vascularised tissue and short residual limbs.
Holly discussed the importance of ensuring that musculoskeletal and phantom limb pain are prioritised and treated by a specialist musculoskeletal physiotherapist. She highlighted the huge impact of unmanaged phantom limb pain and the importance of effective and early treatment. Holly talked about the types of treatment that can be offered for musculoskeletal pain. She also spoke about the various treatment options for phantom limb pain, depending upon the cause of the pain, including myofascial/scar release and desensitisation electroacupuncture and neuromatous.
Demetrius explained the problems that can arise following amputation including excess soft tissue caused by residual limb shrinkage problems with inadequate soft tissue coverage leading to pain and ulceration and the treatment of neuromas with TMR (targeted muscle reinnervation).
Jon talked about the type of orthopaedic issues that can arise following an amputation including short limb length requiring limb lengthening, prominent bones, heterotrophic ossification, bone infection, degenerative joint change and the role of osseointegration. He also discussed and the importance of having both plastic and orthopaedic surgeons perform such surgery.
The team concluded by explaining how important it is to have a multi-disciplinary team approach to treating amputees to ensure the best outcome for the patient.
We received several interesting questions at the end of the talk including whether TMR should be considered at the time of the primary amputation in order to prevent neuromas developing in the first place, considerations relating to neuromatous treatment and when osseointegration is or is not appropriate.
Any enquiries to the Birmingham Amputee Clinic can be sent to firstname.lastname@example.org.
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A Q&A with Holly King about the benefit of a multidisciplinary team approach in amputee care can be found here.
If you were unable to join us for the live webinar, you can access the recording here.
The webinar is free to view but standard registration details are required.
Life beyond injury
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