Casting Brims and made-to-measure sockets RESPONSES

Casting Brims and made-to-measure sockets RESPONSES

Randy McFarland

7/28/2003

ORIGINAL QUESTION:
I looked up past discussion on TF casting philosophies on the List
Archives. Hand casting, casting brims and the made-to-measure CAD
methods were recognized as viable methods to create the initial
diagnostic socket. Regarding brims, which styles have you had good
success with? With the brims, are you able to come close to
approximating the proper IC location/contour/fit, or do you end up
having to create that during the initial fitting? Same question for the
made-to-measure sockets.
Randy McFarland, CPO Sunny Hills Orthopedic Services
RESPONSES:
I've used the Otto Bock ETS system since 1996 or 97. The one thing the
sales rep guaranteed me was that they would not fit! He told me that
they should be about a 90% fit at best.So far, he was right. I use the
Scandanavian IC design and modify the medial and medial/posterior areas
as required. I have not had very much difficulty with holding
suction.On every fitting, I pour the test socket and make the cast
modifications. I don't believe that I have been able to send a test
socket, with only the fitting modifications, to be fabricated.The system
has some drawbacks, i.e. you cannot ask for specific modifications from
the outset. They will only accept circumferences, length and end shape.
(the conical shape is comical as the deepest point is in the center
instead of the lateral side where the bone will be.)All said and done,
I'm very satisfied and the price is right!
I have had good success with the ipos casting brims for both:
handcasting and CAD design.
   The IC casts, based on ipos brims, need modification as follows more
often:
   Higher IC containment, IC containment extended forward (toward
anterior), reduce trochanter pocket (too large in most cases) and reduce
in rectus femoris area (gapping more often). Otherwise they provide a
relatively good solution - all the rest needs to be done in the
thermoplastic check socket.
   ipos' soft brim is used with good success by some colleagues for
initial geriatric fitting. I have always had the impression that these
brims do not deliver enough functional contouring but as it seems they
are very acceptable and comfortable to the non-active patient.
ipos' Hard brim provides very much the german version of a typical
quad socket and the ipos CNC brim goes in the direction of a hybrid
socket (sloped ischial support but no ischial containment in the medial
ischial/ramus aspects).
   As so often in O&P, I believe it is a question of personal preference
and related experience with a system.
I am not familiar with Hosmer brims or with the ETS socket design and I
would be interested in learning more. Please post the responses.
I use the hand casting method with diagnostic check socket , So you can
say that I use a custom made brim and I start working from there .

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