Very Short Transfemoral replies

Very Short Transfemoral replies

ecat

10/28/1997

Dear all, thankyou for your prompt and helpful replies to my Q. about Very
Short Transfemoral fitting. I am encouraged that I was probably on the
right track and now have a clue or two to go on. Herewith the replies that
I received. Thanks again, Richard Ziegeler



Dear Richard:

Here are my comments about your short ak amputee:
In several occasions, I've learned not to touch any system used by my
amputees for so long; they will have great trouble in getting used to a
different one; however, if friction is a problem, I think you could use
some kind of interface that would stick to the stump and avoid any kind of
friction on the stump; I mean the TEC or even some very soft thermoplastics
like the NORTHVANE; with these, all the friction would be done between the
liner and the socket, leaving the stump well protected.
As for suspension, I've been using the neoprene belts but, each case is a
case, and a trial and error system will be the best advise.
Hope it helps.
Best regards

<Email Address Redacted>

Hi,

We have had very good success with ICEROSS suspension for A/K's, and
presently it is our primary suspension. However, the shortest femur we
have
fitted is 3-1/2 inches, with fairly soft tissue and appreciable scarring.
This particular patient is A/K - B/K bilateral (or T/F-T/T) and had always
worn a pelvic belt and a heavy hip joint, which he broke periodically.
With
the ICEROSS, he now has no belts, and he probably would never return to the
pelvic suspension arrangement. We are using ICEROSS with
ischial-containment sockets. If your patients's prosthesis is endoskeletal
or has a socket-in-frame arrangement, you might be able to retrofit it with
a latch to try silicone-sleeve suspension.

C. Martin, CPO
I have a patient similar to yours but female and in her early forties. We
had trouble with the early quad/conventional sockets and although she was
safe and functional she too had a terrible gait. She has done
significantly
better for the last seven or eight years since we fit her with an IC socket
and custom made silicone 3S liner. The liner is attached with a velcro
strap
sewn to the old threaded D-ring that was used in the original 3S design.
The
strap runs through an extended distal opening in her flexible inner socket
and onto velcro pile on the outer furface of the flexible socket. This is
key because like the lanyard it allows her to pull in and minimize stump
circumference and the bunching effect of pushing into the necessarily snug
fit. The flexible ( semiflex ) socket is held in place with a heavy duty
snap and also the lock and key shape. Donning/doffing requires it come in
and out of the rigid socket each time. In other patients I have simplified
this without the flexible socket by running the strap thought to the outer
socket. We use a TES belt to as auxillary suspension and to help control
rotation.
Hope this helps
Keith Cornell CP
Richard,

I have been attempting to change a patient in a similar situation from a
quad style socket with hip joint and pelvic band, as well as shoulder
suspension, to a more progressive ischial containment socket design with
a silicone liner with locking pin suspension system. We are currently in
the
second month of working with the change, and it has been successful in the
office, but
the patient has expressed some difficulties with the system once he goes
home
and is outside of the sheltered environment. His gait improved
dramatically
with the new system.... The pt. is a 6 foot 200 lb. patient... he was
using a safety knee and single axis foot with the old prosthesis, and this
was
also switched to a new system... an Otto Bock 3R80 Rotary Hydraulic, and
a Seattle light foot. He had gone from a 30+ degree abducted gait with
circumduction
and hip hiking to a more natural alignment, with a narrower base of support
and
closer to normal forward progression. In my eyes, the initial switch was
very successful... the patient on the other hand is having difficulty
adjusting
to all the newness. I have considered removing some of the variables, such
as the new
knee unit, and replacing it temporarily with the type that he has been
accustomed to for the
last 12 years. At a later date I will try to get him to change to the
newer unit.

The one thing that the patient has expressed satisfaction with has been the
new socket
design and suspension mechanism. He was not using suction suspension
before, but was wearing
a 5 ply wool sock with the quad socket. I used the largest prefabricated
suspension
sleeve from Iceross, and this worked very good. After practice donning the
silicone
sleeve, the patient was able to successfully don the system with the pin in
the correct position for
easy insertion into the socket attachment mechanism. I used a polyethylene
inner
socket with an Iceross thermoplastic attachment kit, which was contained in
a
laminated frame with a hole for button access.

The patient is coming back to see me next week. If you would like, I can
take a digital
photo of the limb and attach it to an email to you. I hope that was at
least somewhat helpful.
I hope to resolve some of his problems this week. It appears to be
primarily the lack of
confidence in the new knee system. Maybe too much change too quickly.
We'll have to
see what happens at the next appointment!

Good luck.

Paul E. Prusakowski, CPO
Shands Hospital at the University of Florida
Richard,

My patients residual limb is quite short as well, and very flabby.
We found that even a few inches of contact with the iceross provided enough

suspension. Again, I'll try to send some pictures next week.

Paul

Dear Richard,

I have a patient that has almost that same residuum. The only difference
is that the limb is semi firm and conical in shape. I fit him in an
ischial containment design with an extra high lateral wall for stability,
Flexible socket, and suction. He pulls himself in and then uses a
silesian belt for auxiliary suspension. I used a lightweight, alignable
system with a rotator and S.A.F.E. foot. He has worn this prosthesis for
5 years now with no problems. He is an avid golfer(3-4 times a week) and
does all the yard work on his 5 acre property. He is in his late fifties.


I hope this info helps

Steve Childs, BOC(P), C.Ped.
Hi Richard,

I've done several of these old-time short transfemorals, even 4 true Hip
Diasartics w/o a femur by using a very unusual Ischeal Containment
variation. There are a number of pictures and a brief description of them
in the article I wrote for the Atlas of Limb Prosthetics, pages 539-552. I
do have some video footage on several that shows how well they walk and
sit.

These are time-consuming and challenging fittings and will only succeed if
all parties are in tune with what is required. I would stay away from
any
roll-on types of liners/inserts, since they actually shorten the residual
lever-arm; the opposite of which you should aim for in this case.

Tony van der Waarde CP(C)



















E.C.A.T
<Email Address Redacted>