Aging - Prosthetics I

Front 1

What to keep in mind for patient selection for prosthetics?

Back 1

Motivation
At least fair health
Healed residual limb
Reduced edema

Front 2

Problem with fitting prosthetics with chronic wounds

Back 2

Don't have a nice stump to work with... makes fitting difficult

Front 3

5 types of foot amputation

Back 3

1. Toe
2. Transmetatarsal
3. Chopart (Midtarsal amp)
4. Boyd (remove talus and fuse tibia and calcaneus)
5. Pirigoff (part of calcaneus left as stump)

Front 4

6 types of LE amputation (not including foot)

Back 4

1. Symes (distal tibia/fibula)
2. TT/BK
3. Knee disarticulation
4. TF/AK
5. Hip disarticulation (HD)
6. Hemipelvectomy

Front 5

3 types of below knee amputations

Back 5

Short below knee (close to knee joint)
Standard
Long below knee (close to distal tibia/fibula)

Front 6

What is a knee disarticulation?

Back 6

Femur and patella left intact
Less trauma b/c no bones cut
Easy to fit prosthetic
Can have a functional knee joint

Front 7

Why do a hemipelvectomy or hip diarticulation?

Back 7

Cancer of femur

Front 8

Types of UE amputations

Back 8

1. Partial hand (finger am,transmetacarpal)
2. WD
3. TR/BE
4. Elbow diarticulation
5.TH/AE
6. shoulder diarticulation

Front 9

5 initial alternatives of care to prosthetics

Back 9

1. Soft wrap/dressings and ACE bandage
2. Soft protector
3. KIWI/Rigid removable dressing
4. Early fit devices - FloTech Device
5. IPOP

Front 10

Time frames for change limb/devices

Back 10

1. Initial Phase (first several weeks)
2. Prepartory device (leave open for adjustibility)
3. Definitiive (finished and covered)

Front 11

Function of Soft wrap/dressing and ACE bandage after ampuation?

Back 11

control swelling
Able to examine surgical site
Dones not require team effort

Front 12

What is a soft protector?

Back 12

Protects limb, custom to patient
Permits removeable for inspection
Made of formed foam material

Front 13

What is a Rigid Removable Dressing/KIWI and why use it?

Back 13

Plaster dressing with thick cushioning
Reduces swelling and allows inspection
Protects limb from injury for someone you are worried about

Front 14

Characteristics of Early Fit Devices - FloTech

Back 14

Can be fit within 24 hours of AMP
Transfers weight around surgical area
*Removeable for inspection
Heavy
Adjustable after surgery

Front 15

Characteristics of IPOP

Back 15

Applied in OR or recovery room
Plaster cast with pylon on end, atatched to foot
Suspended by waistbelt or shoulder strap
Allows 5-7 lbs WBing (??)

Front 16

IPOP vs. FloTech

Back 16

IPOP not good for DM, vascular issues, or when a team does not know IPOP very well
*Ya can't inspect it b/c it stays on for 7-10 days

Front 17

Benefits of IPOP

Back 17

Permits WB within 24 hours
Psychological benefit
Reduces contracture
Protects limb (hard plaster)
Controls edema

Front 18

Characteristics of a preparatory prosthesis?

Back 18

Plastic socked on pipe, attached to foot
Completely function
Reduces cost of first device
Able to be made more rapidly than definitive device
Permits adjustments to socket and alignment for changes
Used for 3 months to 1 year

Front 19

Characteristics of a Definitive Prosthesis

Back 19

Appears as a shaped leg
May be soft foam or hard plastic
Does not permit adjustments easily b/c no pylon
Usually an exoskeleton (???)

Front 20

Replacement sockets

Back 20

All levels of prosthetics
Allows re-use of knee/pylon
Permits use of higher level

Front 21

Exoskeleton

Back 21

Hard outer plastic construction
Durable to kneeling, getting bumped
Males and outdoorsman like it
Heavy

Front 22

Endoskeleton

Back 22

Soft foam outer construction, inside hard tube
Less durable to pressure
Very cosmetic in appearance

Front 23

2 types of materials and properties

Back 23

1. Standard weight = heavy, less expensive, more options (not really true anymore)
2. Light weight (carbon graphite/titanium): 40% lighter, more expensive

Front 24

5 types of prosthetic feet

Back 24

1. Passive ankle motion Sach (solid ankle cushion heel) foot
2. Articulating Ankles - single axis foot/Greissinger foot
3. "energy storing" Seattle/Flex Foot/ C.C II Foot
4. Multi-axial Energy storing feet College Park
5. Feet with vertical loading pylons

Front 25

What is a Passive Ankle Motion SACH

Back 25

Solid ankle cushion heel foot
Lighter than other feet
No moveable parts
Good for a person who does not AMB much (household AMB)

Front 26

What is a Articulating Ankle - Single Axis Foot/Greissinger Foot

Back 26

Uniaxial: allows PF/DF
Less cosmetic
Heavy due to joint component

Front 27

What is a "Energy Storing" Seattle/Flex Foot/ C.C. II Foot

Back 27

Push off from compressed heel
Plantr flexion by heel material compression
Can be very cosmetic

Front 28

What is a Multi-axial Energy storing foot (College PArk)

Back 28

Adapts to irregular surfaces
Provides energy for push off
Allows INV/EV, DF/Twish in midfoot and rearfoot
For higher level patient

Front 29

Benefits of Feet with vertical loading pylons?

Back 29

Adapts to irregular surfaces
Absorbs shock
Reduce vertical stressed on limb/back

Front 30

Torsional Pylon

Back 30

Absorb rotational forcs
Reduce shear forces on limb
Increase weight though
Good for golfers

Front 31

2 types of BK sockets

Back 31

TSB and PTB
TSB is the way to go

Front 32

Hard sockets

Back 32

Not used much anymore
Typically constructed of hard plastic
Used with 5 or more ply fit
More liekly where heat of insert not desired
Less bulky at top when finished

Front 33

Soft socked characteristics

Back 33

Soft white foam liner
Allows greater force tolerance at skins surfac
Often used with diabetic pts
Fits into hard socket
Why not use this (????)

Front 34

Gel liner characteristics

Back 34

Total contact gel insert
Distributes forces and shear
Creates seal to skin for suspension
Rolls onto limb

Front 35

Different types of "suspension"

Back 35

Sleeve
S C cuff
Waistbelt
Self-suspending PTS
Pin locking mechanisms
Vacuum assisted suspension
VAC-PIN combo suspension

Front 36

What is a self suspending PTS suspension?

Back 36

PTB supracondylar/ removable medial brim
Grips over medial condyle with a wedge

Front 37

How do pin locking mechanisms work?

Back 37

Holds prosthesis on with suction sleeve
PRovides soft liner to reduce shear
Usually used for patients with mature residual limb

Front 38

What are vacuum assisted suspension good at managing?

Back 38

Volume
Persipration
Improve circulation
Used with mature stumps

Front 39

Benefits of VAC-PIN suspension?

Back 39

accomodates various shapes
Reduces distraction of pin liners on distal limb
Allows locking liner suspension

Front 40

Corset stabilizing component

Back 40

Leather corset about thigh with side metal joints (rare to use)
Reduces pressure onto limb/socket interface

Front 41

How to wrap a residual limb

Back 41

4" ACE for BK
Snug distal, loose proximal
Re-wrapped every 4 to 6 hrs
Shrniker may be substituated, elimnates need to rewrap

Front 42

Sheaths

Back 42

Nylon material, reduces friction
Absorbs moisiture
Worm next to skin
Not always used

Front 43

Socks

Back 43

1, 3, 5 ply common
Synthetic, wool, cottong
Used to adjust fin in socket on BK
Always used

Front 44

Donning sequence for BK - conventional

Back 44

Sheath (optional)
Sock
Insert (if used)
Slip into socket
Pull up and fasten suspensions

Front 45

Donning sequence for BK - roll=on suction type

Back 45

Roll lliner on limb
Socks
Insert
Slip into socket until lockingmechanism catches or roll up sleeve
Will automatically adjust to changes, limited volume

Front 46

How to ensure proper fit of prosthetic?

Back 46

Pressure from PT bar btw knee cap and tib tubercle
even sock marking over remainder of limb

Front 47

When to add socks?

Back 47

When pressure at distal aspect of patella
When distal pressure on ANT distal tibia

Front 48

When to remove socks?

Back 48

When pressure at tib tubercle

Front 49

What biomechanical features do you look for during gait with BK amp?

Back 49

Smooth rollover from heel strike to push off
Slight lateral socket displacement at mid-stance