bj: Obese B/K patient socket design, suspension??/Responses 2nd 1/2

bj: Obese B/K patient socket design, suspension??/Responses 2nd 1/2

In cases where rotational instability cannot be controlled with socket
configuration or by alignment have your patient try the De-Ro socks that grip
the interior walls of the socket. These socks provide stability but are
impossible to don completely in most cases. A suspension sleeve applied over
the proximal portion of the socket also adds control, but will also roll down
in cases of massive thigh volume.
The only positive remedy is to apply sticky-back Velcro to the interior of
the socket. A one inch strip located laterally in the proximal socket
interior always controls rotational instability. The reason that I only use
this method as a last resort is that it prematurely wears out the nylon Alpha
cover, but it works!

                                                 G.M. Yackley C.P.


The rolling of the liner is a problem. I haven't found a way to solve it. I
find it difficult to fit someone with this body build with a belt.
As for socket rotation, try a PTS style brim. The additional M-L stability
will also probably help.
Ron Kidd, CPO
Columbus, Ohio


I haven't tried attaching the Alpha to a waist belt but it could work. One
time I put several pieces of sticky back HOOK Velcro on the socket. When
the residual limb was inserted, it didn't rotate with this addition. This
was a very soft limb with no bony definition that could spin around on the
suspension pin. The Velcro worked nicely.
Good luck. Molly


 I can appreciate where you are at. I have fit several rather large
patients and I have found the following to help. You must rely on
hydrostatic principals to assist in weight bearing much more so than with an
average residual limb. You must also keep the posterior trims higher than
you would normally in order to produce enough anterior directed force
through the soft tissue for the effect is translated at an angle. I have
also found that enlarging your modifications to enhance the physical weight
bearing capabilities helps and also assists in preventing rotation. You will
however limit the already limited ability to bend the knee but it is all a
trade off. I hope this helps, and please feel free to call me if you have
any questions or comments. Michael Link College Park 1-800-728-7950



Rotation of the socket; I feel that it is between the socket and sock that
where the rotation occurs. Use anti-rotation A/P design that is when you put
your fingers on the spots to mark the A/P make those spots deeper. It as
simple as that, you will increase the A/P area and the limb will not rotate
in the socket.
I simply don't like Alpha liner on fleshy persons. On heavyset persons that
have had a short limb, we used Ageris liner with no pin and put a 3-S liner
over that. The 3-S liner is graduated, stiffer at distal end and compresses
the soft tissue. The Ageris liner is real stretchy and goes over the knee so
no swelling posterior of the knee. They really stick to each other.
And the last thing we use is a patient adjustable posterior wall that allows
the patient to slide down into the limb and then tighten up the A/P.
To see one you could go to the Sydney Paralympic on the cycling track.
That's all for now
John


On obese patients I have found the protocol of cutting the liners at the PTB
level the most proficient. This is because of the funnel shaped thigh. I only
use the Regular Iceross with matrix to reduce the vertical translation or
pistoning. I apply sufficient proximal femoral condular control to stop the
rotation and to help with some more suspension control.

Good luck

John Hattingh CP


If she is that fleshy then maybe get rid of the Gel liner and go to a thin
Iceross with distal matrix. She'll have to use alcohol to get liner on and
keep the liner trimmed down in the socket at the lowest level possible
without compromising suction. Then you could possibly use a Silesian belt to
control the rotation.

Good luck

Doug Reichert, CP


It's always tough with the grossly obese ones. The best advice I can offer
is to modify using a V strategy. I've had limited success with this. The
base of the V being the tib. The top of the V is across the gastroc.
This hefty modification, creating the V shape (to some extent) helps
control some of the rotation. With a limb so large and fleshy, you can
generally afford more modification on the ant tib musculature and med tib
plateau without discomfort or breakdown. Good luck- we've all been there!

Joan, C.P.


I have run into the same problem. The Alpha sleeve may be your only choice
since it is the only sleeve with enough taper to even have a chance. I
have had good luck using Goop as in Shoe Goo glue to stick straps to
the alpha. Don't use too much and let it dry overnight with a plastic bag
and ace wrap over it and you can stick most anything to the liner.
Silicone and Barge don't work, I've tried. You might put Daw edge tape
over the socket edge to reduce the cutting on the liner. I have not tried
a belt, we generally cut the liner at the top of the socket but a strap
might get rid of the rotation. Good luck!

Wayne Daly, CPO


I am sure you are going in the right direction with the idea of the waist
belt.
Why not attach your Y strap directly to the socket.
Good luck with this challenging case.
Paul Werner, CPO


How about trying a simple garter belt? With anterior and posterior clips?
That way you wont have to sew anything to the liner.

Eric Schwelke, C.P.O.


Jeff , regarding your BK patient, I have had some success using a hard
socket with high M-L trim lines suspended by a Silipos gel suspension
sleeve. The cast is taken by using standard splint technique emphasizing the
contours for media-lateral support and doing additional modification to
enhance weightbearing. Distal weightbearing is increased as tolerance
permits. Hope this helps.Dave Gross,C.P.


I fit my obese BK's with custom (not off the shelf) Fillauer liners.
They are more rigid than gel liners. With all that adipose tissue she
doesn't need anymore padding. The custom Fillauer liners tend to hold
shape better and move around less. Added bonus: they are cheaper than
gel liners and you can fabricate them yourself if you like.

Matt Mullins CP


Have you considered custom making a liner? It's a pain, but the only way I
know to accommodate large thighs. We have the highest incidence of obesity
in the country here in Michigan and 300# is not too unusual here.
Wendy Beattie, CPO