Short AK Responses

Short AK Responses

Janette Morris

8/12/2002

Thank you so much to everyone who responded. I was
unable to successfully attach the wonderful pictures
contained in the first response. If anyone is
especially interested in seeing them, email me & I
will try an alternate method...

Original message:
I have a client with a short (4) AK amputation. He
has always worn a quad socket w/ hip joint & pelvic
band, sock fit. I've heard of successful conversions
to Iceross liner suspension, IC socket, with no need
for auxilliary suspension.

I'd appreciate any information on this subject...

-------------------------------------------
I have been noticed by Anton Johannesson that you have
this patient
with a 4 AK amputation. I am happy to send you these
pictures of how we
made this prostheses last year. The Iceross was cut as
long as
possible on the medial side. The heigth of the medial
side of the Liner
determines how god suspension you can obtain. In this
case there was noe
critical scar tissue distally and it was easy to put
on the liner, using a
two colored Iceross with fabric cover. We lett the
amputtee use the
liner for apr 14 days before casting. This in an
atempt to have some
pre-shape of the soft tissue and also to see how he
managed to don the
liner by himself.
If you have any questions to this or my pictures, you
are welcome to
contact me or Anton Johannesson again.

---------------------------------------------

I had a patient who came to see me for a new
prosthesis. Her limb was approx. 4-5 in length.
Another provider attempted to fit her with a liner/pin
system, which was unsuccessful:
         1. Limb was fleshy and rotation was a
problem
         2. When she became sweaty, the liner would
slide off her leg.

 I fit her with an ischial containment socket, high on
lateral side to increase overall surface area. She
wore a 3 ply fit, velcro on outside of socket to
prevent sock from falling into socket. I was able to
fabricate a silesian belt approx. 6 in width, padded
with felt over contralateral hip, again larger surface
area to cover allowing for better suspension. I tried
a TES belt, however, this was too bulky. She was
happy with the fit/design and currently wears
prosthesis full-time
  Hope this helps.

----------------------------------------------
My experience with very short AK fittings is typically
to use
traditional
pull-in suction suspension with a very high medial and
lateral wall.
You'll
have to be prepared to make a few test-sockets
before getting the
total
contact fit you want in walking and sitting. If you
look at my website
you'll find an article with photographs dealing with
HD amputees with
some
residual tissue. The socket design is very similar
for these. In all
cases
a silesian or TES-style belt was worn.


-------------------------------------------------

I recently fit a new amputee (healthy male, mid 40's)
who was a very
short AK amputation, 4 or less, using an Iceross
transfemoral locking
liner. I also used the hip joint and pelvic band, not
for suspension,
but to act as a substitute for the compromised hip
abductors. With
such
a short lever arm, there is no way for the abductors
to support the
pelvis during mid-stance. Even with an IC socket to
prevent (in
theory,
at least) a lateral movement of the socket, there
simply is not enough
of the femur left to stabilize with the lateral wall
of the socket and
support the body's weight. The liner is doing a great
job of
suspending
the prosthesis.


-----------------------------------------------------
We have switched several of our patients to this
system. One of them
had a
short amputation about what you describe. Before this
he was wearing
the
usual quad suction socket. We used the Iceross
comfort gel with the
Coyote
locking pin system. I believe the sleeve is a 3mm.
He is happy with
the
system. It still provides suction even with volume
changes and is
easier for
him than a draw sock. Iceross also makes a
transfemoral suspension
liner
that also works well. The 2 problems that we have run
into is first,
the
sleeve does not stop rotation if the residual limb is
flabby. Maybe
the IC
design will help that. Second, most short amputees
have to jiggle
around
and sometimes reapply the leg to get the pin to engage
in the locking
platform. One of our patients rejected this system in
part because of
this
problem. I guess either you could try a suction socket
and the iceross
sleeve without a locking pin or OWW makes a lanyard
locking system that
uses
a string to guide the amputee when putting the leg on.
 I have not
tried it
yet with any of my patients but it is supposed to
allow the amputee to
don
the leg when sitting. It looks to me like it would
make donning easier
than
using a pin.
As long as your patient doesn't need the support from
a pelvic hip and
band
and has a little patience when learning the donning
process, I don't
see why
he or she can't be switched to this system.

-----------------------------------------------------
 I would be interested in this as well. I am in and
Iceross liner with
a 6
residuum, but need to use a suspension belt to
compensate for the
tendancy of
the hip and reisduum wanted to rotate out.


----------------------------------------------------
Odds are against it. But conversions to happen
occasionally.
How long have they been in their quad system?
How enthusiastic are they about the change?
It ultimately may require trying it for a time in
order to determine
feasibility of acceptance.
Good luck.


----------------------------------------------------






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