With this background, some of the most important judgments of the Supreme Court in the last ten years in the field of social rights have been analysed, looking specifically at the enforcement and justiciability of the right to food, right to education and the right to health. The developments in the last decade are significant as during this time the deleterious effects of globalisation and threats of deprivation of basic social rights have been acutely felt and this has been studied.
Hip Disarticulation and Transpelvic Amputation: Although the anatomic differences between hip disarticulation and transpelvic hemipelvectomy amputations are considerable, prosthetic component selection and alignment for both levels are quite similar.
The major differences are in socket design and will therefore be discussed in some detail. A full surgical report identifying muscle reattachments along with postoperative radiographs can be extremely valuable during the initial examination of the amputation site, particularly if any portions of the pelvis have been excised.
This information, combined with a thorough physical examination and a precise plaster impression, will influence the ultimate fit and function of the prosthesis. Many authors have noted that the rejection rates for lower-limb prostheses are the highest at these proximal levels.
As a practical matter, only those who develop sufficient balance to ambulate with a single cane or without any external aids at all are likely to wear such a prosthesis long-term. Those who remain dependent on dual canes or crutches for balance eventually realize that mobility with crutches and the remaining leg, without a prosthesis, is much faster and requires no more energy expenditure than using a prosthesis does.
Prosthetic fitting is typically limited to motivated and physiologically vigorous individuals; still, a significant number do not become long-term wearers.
To investigate this further, the senior author T. W studied a group of 20 male and female hip disarticulation and transpelvic amputees who were representative of the age and diagnoses typically encountered. After a 3-year follow-up during which these patients were fitted with a totally new prosthesis that included a novel silicone rubber socket Fig 21B Ninety percent of those polled reported that increased comfort was the main reason for using the prosthesis more often.
Other significant reasons were less effort when walking and improved appearance of the prosthesis. Interestingly, the actual weight of the prosthesis had increased in several cases due to incorporation of more sophisticated componentry such as units to absorb torque while walking.
Often shoulder straps were required for suspension. Gross pelvic thrust was required to propel the prosthesis, and a vaulting gait was common. A radical departure, later termed the "Canadian" design, was introduced by McLaurin in Fig 21B This unique approach demonstrated the feasibility of using unlocked hip, knee, and ankle joints that relied on biomechanics to achieve stance-phase stability while permitting flexion at the hip and knee during swing phase.
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This is now the standard for prosthetic fitting worldwide, and locking joints are very rarely necessary. A molded plastic socket encloses the ischial tuberosity for weight bearing, extends over the crest of the ilium to provide suspension during swing phase, and affords excellent mediolateral trunk stability by fully encasing the contralateral pelvis.
The prosthetic hip joint is attached to the socket anteriorly, and this results in excellent stance-phase stability plus good swing-phase flexion.
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