(Fwd) replies for difficult bk fitting

(Fwd) replies for difficult bk fitting

andy d'entremont C.P.(c)

5/18/1998

------- Forwarded Message Follows -------
From: Self <Single-user mode>
To: <Email Address Redacted>
Subject: replies for difficult bk fitting
Date: Sun, 10 May 1998 20:23:15

Dear List;

Sorry it has been a while since I have received your suggestions
regarding a difficult bk fitting. I compiled them and sent them to
the wrong address. I am posting the replies I have
received so far. We have decided on the supra-condular suspension
from the thigh section at this point. I forgot to mention that I had
tried other strapping methods attached to the uprights (fig 8 straps,
supra-pattelar straps). These provided more suspension but were
uncomfortable for the client and were abandoned.

Here are the responses I have received so far. Thank you all who
replied! Much appreciated. (original post at the end of this message)

Andy;

I understand your frustration ! I hope this helps ................

An alternative to a waist belt with side joints and thigh corset is
what two of my old patients refer to as a pick up strap. It is
simply a 1 1/2 cotton webbing strap which provides supra-patellar
suspension. It is placed in a manner similar to that of the proximal
strap on an anterior knee pad for a KAFO. It uses a three prong
safety buckle for adjustability.
******************************************************

Good Evening,

I am a rt. b/k and also a registered prosthetic tech. For myself , I
have found that the Alpha without the locking pin has made ALL THE
DIFFERENCE in the world in the condition of my limb. The distal
locking pin type have always had a very bad pulling sensation on my
limb.

Try using the Alpha with an Alps clearline suspension sleeve. Or
maybe just the Alpha along with the thigh lacer??

Take Care,
Jeff A. Zeller, RTP
<Email Address Redacted>

********************************************************

Dear Andy;

Have you tried using Supracondylar suspension socket with the side
joints and ischial weight bearing proximal section. If the residual
limb is very conical, then suspension without a belt is a concern. We
have used a PTB-SC socket with pelite insert in combination with
molded thigh corset (polyethylene, anterior opening) or ischial
containment proximal section in a number of cases, though not for
polio.

 It is important to include a horizontal bar of 5mm pelite at the
 posterior
section of the trans tibial socket (located approximately 3 cm distal
to the posterior shelf and sized approximately 1cm wide and 4-6cm from
side to side). This bar will allow the liner to lock into the socket
and prevent any pistoning of the socket and the liner. ( we recommend
a separator sock over the liner or the bar may lock in so well that
doffing the device is difficult). The supracondylar suspension should
prevent most pistoning of the residual limb in the socket.

I would suggest looking at the 17B97(20mm uprights) knee joints from
Otto Bock. This outside hinge can operate as a simple hinge and it
can be locked in extension if your client so desired from time to
time. If your client is capable of adjusting the foot to shank angle,
I would suggest an adjustable ankle and a SACH foot. This would allow
him to increase the plantarflexion angle should he wish to operate
with the knee in free swing and requires a little extra extension
moment. at the knee.

Good Luck

Craig Smith C.P.(c)

*****************************************************

Dear Andy:

Regarding your mid 40s client for whom you would like to make a more
comfortable prosthesis my suggestion is to try the supra condylar with
pelite liner.

Good luck to you.

John Lang, CPO

**************************************************
Andy

If the corsett is a main means of suspension, he may consider wearing
a sheath under an Alpha liner. This may provide a little breathing
but still give him considerally more comfort in his prosthesis. I am
talking about a non-locking liner. Just an idea; how are you anyway. I
am defenitely coming to the convention and looking forward to it.

Glenn

**********************************************

Hello
looks lik e you tried the new stuff.
have you tried a dog collar ie leather strap which will loop from
either med or lat joint upright outside to opposite side of stump?
will pull on stump to aid in suspension. also have you increased
contours of uppers w/ pelite b/ups between corset and uppers? these
have helped me in the past w/ long tibia only BK. yours <Email Address Redacted>

*****************************************************
ORIGINAL POST:
Dear list;

I have client whom I would like to make a more comfortable prosthesis
and one as functional as possible. (Obvious goals)

He is a bk amputee who had polio as a child and had shoe lifts and
kafo's until 15 years of age when he opted for a bk amputation. He is
now mid 40's. He has always used a prosthesis - ptb, pelite with side
joints and ishial/gluteal bearing thigh lacer with a standard sach
foot.

His prosthetic side is a basically well atrophied, flaccid limb. He
has no muscular control whatsoever. All of his prostheses in the past
have had free outside knee joints with a back check and the foot
aligned in a great amount of plantar flexion to provide a knee
extension moment to 'lock' or stabilize his knee. He also depends
solely on the thigh lacer for suspension. This has never been very
adequete, as he pistons a good half inch or more. He always has worn
at least 12 ply of socks.

I recently tried a Icecast technique, with a distal cup, then an
iceross sleeve. Distal cup needed due to a tapered shape. He also wore
a 3 ply sock over the sleeve and then into the shuttle cock for
suspension. I tried a reflex vsp, then a modular 3 flexfoot. on him. I
used outside joints and thigh lacer. He has always refused to wear a
waist belt in the past, and I could not convince him to use one as an
auxillary suspension in this prosthesis.

He has given this system a very good try, but cannot get used to the
suction, pull on his distal stump. The weight of the joints and lacer
add to the equation. I really would like him to wear a waist belt, but
he refuses. He wishes to stay with the modular 3 foot, but wants to
abandon the iceross suspension and go back to a pelite liner with at
least 9 ply.

I have therefore recasted him for such a socket and will try a
silicone sheath to give him more comfort due to the pistoning I
expect to see. I have also showed him an alpha liner, but he thinks
he would like his tissue to 'breathe'. He feels the active silipos
sheath may help because of the sheath on the inside.

I wonder if anyone has any other suggestions?

Andy d'entremont C.P.(c)
Saskatchewan, Canada
Andy d'Entremont
<Email Address Redacted>

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