THE JAMES LAWRENCE KERNAN HOSPITAL

EVALUATION AND TREATMENT

Amputee Clinic

Date: 5-17-82

Unit Number: 05-52-32

Patient’s Name: LONG, Deepa

This is the first Clinic visit for this 19-month-old female who was presented to the Clinic with her mother and was referred to the Clinic by Mrs. Chaya Kaplan with the Social Service Department of Kernan Hospital. This young lady presents with a very short below-knee amputation of the right lower extremity. This child from India where, at some time in her early infancy, perhaps before 12 months of age, she was involved in a train accident at which time her leg was traumatically amputated. Her mother was killed at the time of this accident. The patient is being adopted by Dr. and Mrs. Long. At this time the stump is unhealed. There is a gross flexion contracture of the distal end of the stump, in an indurated area over the distal end. It would appear that the stump is essentially flaccid as there is no apparent voluntary muscular control of this stump. In addition to this, it would appear that there is an anterior dislocation of the hip. X-rays were taken of the patient’s hip and the stump at this time. It was Dr. Decker’s opinion that further investigative and diagnostic procedures be carried out in the form of an arthrogram of the right hip to determine the exact status of the hip joint. Dr. Decker will follow this child on a private basis regarding her hip and further considerations regarding prosthesis.

William Neill, XIII, R.P.T.

Chief Physical Therapist

THE JAMES LAWRENCE KERNAN HOSPITAL

X-RAY REPORT

Date: 5-17-82

Hospital Number: 05-52-32

Hospital Location: OPD

Patient’s Name: LONG, Deepa

Right Hip and Thigh:

There has been a below the knee amputation. The remaining knee joint and femur as visualized appear intact. In the one view of the pelvis and hip obtained, a small segment of the lateral aspect of the femoral head is uncovered by the acetabulum. Although this is felt to be positional in nature, the possibility of a partial subluxation cannot be ruled out; if clinically indicated, additional views of the right hip should be obtained for further evaluation.

Nathan B. Hyman, M.D.

IRA WEXLER, M.D., Ph.D.

MEDICAL ARTS BUILDING

11085 LITTLE PATUXENT PARKWAY

COLUMBIA MARYLAND 21044

Date: June 2, 1982

To: Scott Decker, M.D.

325 Hospital Drive

Glen Burnie, MD 21061

RE: Deepa Long

Dear Doctor Decker:

Your patient little Deepa Long was examined and tested in my office today. She is now 19 months old, recently arrived from India, with a amputation at the right knee.

Her examination indicates a flail remaining thigh; grossly, no visible difference is seen in the circumference of either thigh but mild, definite atrophy of the gluteii on the right side is present. The shortened thigh has a soft consistency to deep pressure, both anteriorly and posteriorly. Manipulating the child into various positions: horizontal, supine, prone, left and right lateral, shows no restoring force present in the amputated leg. The thigh simply assumes passively, the dependent position due to the force of gravity no matter which position the child is held in. Some remaining skin sensation is evident; pitching the skin in the inguinal or lateral flank region does cause some withdrawal but distally towards the stump sensation is lost.

Surface electromyography was performed on the anterior and posterior compartments of the right leg and comparison made with the similar segment of the left. No visible muscle action potentials could be seen, from anterior or posterior portions of the right thigh, despite movement and agitation of the child. Similar recording from the left thigh showed abundant muscle action potentials to be present with even only slight movement of the left leg.

The conclusion reached on the basis of today’s clinical and electrical examination of the child is that no viable muscle is functioning in the remainder of the right leg – up to the inguinal region. The mild atrophy seen in the right gluteii muscles suggest these may continue to atrophy in the future; the conclusion being that the right lumbar and sacral roots may have been avulsed. If such nerve root avulsion has taken place, outpouching of the torn roots might be visualized in a lumbar myelogram. The child might be considered for nerve grafting if such proved to be the case. The sacral nerves on the left side are normal, hence, I do not anticipate rectal sphincter difficulties although a sphincter examination probably should be done from time to time.

I hope this report will be of some value to you in the future management of young Deepa.

Yours truly,

[Signature]

Ira Wexler, M.D.

IW/nac

c.c.: S.P. Auerbach, M.D.

1400 Wiklo

Apt. 495

Lousiville, Kentucky 40205

S. PEARSON AUERBACH, M.D.

ORTHOPEDIC SURGERY

1003 DOCTOR’S OFFICE BUILDING

230 EAST LIBERTY STREET

LOUISVILLE, KENTUCKY 40202

TELEPHONE (502) 584-6171

June 16, 1982

Dear Mrs. Long:

I am sending a copy of the examination on Deepa, she had an avulsion nerve injury. However, I think she will be able to handle the prosthesis.

Enclosed is the information I was able to find for you. Hope it will be helpful.

Please call if I can be of anymore help.

Sincerely,

(signed)

S. P. Auerbach, M.D.

THE JAMES LAWRENCE KERNAN HOSPITAL

EVALUATION AND TREATMENT

Amputee Clinic

Date: 5-17-82

Unit Number: 05-52-32

Patient’s Name: LONG, Deepa

—2—

taken of the patient’s hip and the stump at this time. It was Dr. Decker’s opinion that further investigative and diagnostic procedures be carried out in the form of an arthrogram of the right hip to determine the exact status of the hip joint. Dr. Decker will follow this child on a private basis regarding her hip and further considerations regarding prosthesis.

William Neill, XIII, R.P.T.

Chief Physical Therapist

THE JAMES LAWRENCE KERNAN HOSPITAL

X-RAY REPORT

Date: 5-17-82

Hospital Number: 05-52-32

Hospital Location: OPD

Patient’s Name: LONG, Deepa

Right Hip and Thigh:

There has been a below the knee amputation. The remaining knee joint and femur as visualized appear intact. In the one view of the pelvis and hip obtained, a small segment of the lateral aspect of the femoral head is uncovered by the acetabulum. Although this is felt to be positional in nature, the possibility of a partial subluxation cannot be ruled out; if clinically indicated, additional views of the right hip should be obtained for further evaluation.

Nathan B. Hyman, M.D.

began fabricstion on prothetic 07/22/1982

leg and gait training began 10/04/1982

between Johns Hopkins stay #1 Overdose 09/23/1982 and Johns Hopkins stay #2 Mylogram dye 12 days after overdose. Leg delivered the day before Chemical Arachnoiditis from these two drugs crossing the blood brainn barrier on 10/05/1982.