difficult AK fitting Response summary Part 1
Ted Trower
Description
Collection
Title:
difficult AK fitting Response summary Part 1
Creator:
Ted Trower
Date:
9/2/2003
Text:
My original question was:
I'm dealing with a difficult AK fitting on an out-of-town client. The
client is very intelligent, 60 years old, very obese with a limb
approximately 1.5 times as long as it is in diameter. He has always worn
a suction socket using lotion to slide in. He has always had difficulty
with this system and has a chronic choke in the distal tissues. The socket
also tends to rotate internally during ambulation. I''ve gotten him into a
socket that is substantially better than his previous fit but still tends
to rotate. The client is unable to pull in to a conventional suction
socket and is unable to tolerate the distal traction of a roll-on pin lock
suspension sleeve. Due to his obesity I don't think he would do well with
a suspension belt.
I'm at a bit of a loss for how to suspend this gentleman's prosthesis. Any
suggestions? What am I forgetting?
-------
I've had to split this message into two emails to stay under the size limit
for O&P-L, responses follow:
=========================================================================
A custom TEC liner with the Harmony system might be what your looking for.
The Harmony system would control rotation, give you great suspension and
would have no distal traction of the pin system. The main drawback is that
the Harmony PRS unit is currently rated at 250 Lbs; however, the weight
limit on the Harmony S unit would be determined by the Pathfinder foot and
may work for your patient. Just a thought...
Byron Backus, CP
Clinical Specialist, Prosthetics
Otto Bock Health Care
----------------------------------------------------------------------------------------------------------------------------------------------------
over the shoulder strap, like suspenders for pants
----------------------------------------------------------------------------------------------------------------------------------------------------
try one of the suction donning devices from lawton. they are great for
that type patient. They must pull up as the pump pulls them in.
Teri Powers-Watts, CPO,CPed
----------------------------------------------------------------------------------------------------------------------------------------------------
Is he too large to get into a gel liner?
If this is a possibility you may have success with a Summit Lock (coyote
design).
If you can achieve some level of socket suspension via the socket fit
and shape, the Summit will assist in rotational control.
You may also want to offer some rotation in the prosthesis in order to
reduce the transverse rotational forces applied to the socket interface.
Hope this is of some help.
Mike
----------------------------------------------------------------------------------------------------------------------------------------------------
Why not try an ALPS no-pin/no-fabric covered liner and attach a Coyote MFG
Summit Rotational strap for both positive suspension as well as rotational
control.
I have fit a KD patient with this system (minus the Summit Strap) to contain
an adductor roll. We were able to use lotion to slide into the socket (over
the ALPS) and she had great suspension. Because she is a KD and the total
surface area of the socket/RL is so great, it allowed her to obtain parial
suction with socks over the liner if she preferred. Actually she liked to
lotion the ALPS liner achieving actual suction suspension. She would roll
the liner up like a condom and roll it onto her limb with no problems.
Let me know what you think.
Karl J. Lindborg CPO
----------------------------------------------------------------------------------------------------------------------------------------------------
16 penny nail. ;-} Sorry Ted but I could not pass this one up. Hope you
had a good summer
(Name deleted to protect the guilty)
----------------------------------------------------------------------------------------------------------------------------------------------------
I accidentally discovered an easy result in one of my resent Transfemoral
definitives. My patient recently lost 100 pounds and I had excessive soft
tissue circumferentially and distally (distal, 4). She measured 34 cm
distally meaning I should have ordered that size or a few cm smaller (two
color Iceross, original liner). I previously had trouble with A/K donning
this liner. So I tried a 45 cm liner. To my surprise it donned easily with
NO distal displacement.
I also use hypobaric socks to control rotation. Ask question if I can help.
Jake R. Wood C.P., F.A.A.O.P.
----------------------------------------------------------------------------------------------------------------------------------------------------
We had one like that many years ago that we used suspenders on. It
worked very well for him.
Ronnie Graves
----------------------------------------------------------------------------------------------------------------------------------------------------
You do not mention when the rotation occurs. The things that I look for (IC
socket) medial wall flat, control posterior to the femur and anterior firm
enough. If the rotation is during sitting or standing up after sitting and
it is an IC socket the Ischial seat might protrude too far posterior as per
the MAS Marlo socket it can be cut off and the containment moved anterior.
If I can help further please let me know.
Best wishes
Gary Seaman
----------------------------------------------------------------------------------------------------------------------------------------------------
Does your socket have sufficient relief for the rectus femoris? Does his
muscle become prominent during ambulation? Also, does the socket rotate,
or the entire prosthesis at the foot level? If it's at the foot, check the
heel stiffness if it is interchangeable.
Jacqueline Schmit, M.S. Resident in Prosthetics
----------------------------------------------------------------------------------------------------------------------------------------------------
What about a roll on liner with a coyote lock? That way he won't get
rotation or distal pull. Can he put on a liner?
Hope all is well with you
Wendy Beattie
----------------------------------------------------------------------------------------------------------------------------------------------------
On a few occasions, I have reflected an Alpha Spirit liner over the brim of
the socket and used 'hook' to grab the 'pile-like' liner. This can suspend
and will also solve rotation. It can be a bit thick at the trim line as it
folds over the brim.
Also, on one occasion, I inserted the 'hook ' into the actual socket at the
prox brim. In order to don/doff the socket, I made a 'tool' that was 1/16
poly-eth (with a Dacron strap) that could be slid into the socket (between
the hook and liner) to keep them apart during the donning/doffing.
Good luck.
Jonathan Naft, C.P.
----------------------------------------------------------------------------------------------------------------------------------------------------
Ted, we have all been there. I would have a talk with him, and if his old
style socket that is working just needs a bit more room, or upgrade without
disturbing anything else, or if you can make some beneficial change without
being radical that may be as good as it gets. Obviously this is going to
drive you crazy with the patient being out of town, and your under the gun
sort of speak. The reality probably is that he / she has compensated for
the socket design with gait anomallies your not even going to believe, if
you were able to note all of them down. Yes, there probably is a solution,
but it just may not be a 100% solvable this time around. Granted Ted I am
taking your experience into consideration. Part of the success for our
profession comes in the package that the surgeon hands us, you have to work
with what you have, not with what you wish it was. Sincerely, Richard L.
Feldman, CPO
----------------------------------------------------------------------------------------------------------------------------------------------------
Perhaps the Harmony system would work. With a Hypobaric sheath it would
slide in well and then be held in volume and rotation under full
vacuum. Jack Ullendahl fits them and I am working on one right now.
Lane Ferrin CP
----------------------------------------------------------------------------------------------------------------------------------------------------
Responses are continued in next message.
Ted A. Trower C.P.O.
A-S-C Orthotics & Prosthetics
Jackson, Michigan, USA
www.amputee.com
********************
To unsubscribe, send a message to: <Email Address Redacted> with
the words UNSUB OANDP-L in the body of the
message.
If you have a problem unsubscribing,or have other
questions, send e-mail to the moderator
Paul E. Prusakowski,CPO at <Email Address Redacted>
OANDP-L is a forum for the discussion of topics
related to Orthotics and Prosthetics.
Public commercial postings are forbidden. Responses to inquiries
should not be sent to the entire oandp-l list. Professional credentials
or affiliations should be used in all communications.
I'm dealing with a difficult AK fitting on an out-of-town client. The
client is very intelligent, 60 years old, very obese with a limb
approximately 1.5 times as long as it is in diameter. He has always worn
a suction socket using lotion to slide in. He has always had difficulty
with this system and has a chronic choke in the distal tissues. The socket
also tends to rotate internally during ambulation. I''ve gotten him into a
socket that is substantially better than his previous fit but still tends
to rotate. The client is unable to pull in to a conventional suction
socket and is unable to tolerate the distal traction of a roll-on pin lock
suspension sleeve. Due to his obesity I don't think he would do well with
a suspension belt.
I'm at a bit of a loss for how to suspend this gentleman's prosthesis. Any
suggestions? What am I forgetting?
-------
I've had to split this message into two emails to stay under the size limit
for O&P-L, responses follow:
=========================================================================
A custom TEC liner with the Harmony system might be what your looking for.
The Harmony system would control rotation, give you great suspension and
would have no distal traction of the pin system. The main drawback is that
the Harmony PRS unit is currently rated at 250 Lbs; however, the weight
limit on the Harmony S unit would be determined by the Pathfinder foot and
may work for your patient. Just a thought...
Byron Backus, CP
Clinical Specialist, Prosthetics
Otto Bock Health Care
----------------------------------------------------------------------------------------------------------------------------------------------------
over the shoulder strap, like suspenders for pants
----------------------------------------------------------------------------------------------------------------------------------------------------
try one of the suction donning devices from lawton. they are great for
that type patient. They must pull up as the pump pulls them in.
Teri Powers-Watts, CPO,CPed
----------------------------------------------------------------------------------------------------------------------------------------------------
Is he too large to get into a gel liner?
If this is a possibility you may have success with a Summit Lock (coyote
design).
If you can achieve some level of socket suspension via the socket fit
and shape, the Summit will assist in rotational control.
You may also want to offer some rotation in the prosthesis in order to
reduce the transverse rotational forces applied to the socket interface.
Hope this is of some help.
Mike
----------------------------------------------------------------------------------------------------------------------------------------------------
Why not try an ALPS no-pin/no-fabric covered liner and attach a Coyote MFG
Summit Rotational strap for both positive suspension as well as rotational
control.
I have fit a KD patient with this system (minus the Summit Strap) to contain
an adductor roll. We were able to use lotion to slide into the socket (over
the ALPS) and she had great suspension. Because she is a KD and the total
surface area of the socket/RL is so great, it allowed her to obtain parial
suction with socks over the liner if she preferred. Actually she liked to
lotion the ALPS liner achieving actual suction suspension. She would roll
the liner up like a condom and roll it onto her limb with no problems.
Let me know what you think.
Karl J. Lindborg CPO
----------------------------------------------------------------------------------------------------------------------------------------------------
16 penny nail. ;-} Sorry Ted but I could not pass this one up. Hope you
had a good summer
(Name deleted to protect the guilty)
----------------------------------------------------------------------------------------------------------------------------------------------------
I accidentally discovered an easy result in one of my resent Transfemoral
definitives. My patient recently lost 100 pounds and I had excessive soft
tissue circumferentially and distally (distal, 4). She measured 34 cm
distally meaning I should have ordered that size or a few cm smaller (two
color Iceross, original liner). I previously had trouble with A/K donning
this liner. So I tried a 45 cm liner. To my surprise it donned easily with
NO distal displacement.
I also use hypobaric socks to control rotation. Ask question if I can help.
Jake R. Wood C.P., F.A.A.O.P.
----------------------------------------------------------------------------------------------------------------------------------------------------
We had one like that many years ago that we used suspenders on. It
worked very well for him.
Ronnie Graves
----------------------------------------------------------------------------------------------------------------------------------------------------
You do not mention when the rotation occurs. The things that I look for (IC
socket) medial wall flat, control posterior to the femur and anterior firm
enough. If the rotation is during sitting or standing up after sitting and
it is an IC socket the Ischial seat might protrude too far posterior as per
the MAS Marlo socket it can be cut off and the containment moved anterior.
If I can help further please let me know.
Best wishes
Gary Seaman
----------------------------------------------------------------------------------------------------------------------------------------------------
Does your socket have sufficient relief for the rectus femoris? Does his
muscle become prominent during ambulation? Also, does the socket rotate,
or the entire prosthesis at the foot level? If it's at the foot, check the
heel stiffness if it is interchangeable.
Jacqueline Schmit, M.S. Resident in Prosthetics
----------------------------------------------------------------------------------------------------------------------------------------------------
What about a roll on liner with a coyote lock? That way he won't get
rotation or distal pull. Can he put on a liner?
Hope all is well with you
Wendy Beattie
----------------------------------------------------------------------------------------------------------------------------------------------------
On a few occasions, I have reflected an Alpha Spirit liner over the brim of
the socket and used 'hook' to grab the 'pile-like' liner. This can suspend
and will also solve rotation. It can be a bit thick at the trim line as it
folds over the brim.
Also, on one occasion, I inserted the 'hook ' into the actual socket at the
prox brim. In order to don/doff the socket, I made a 'tool' that was 1/16
poly-eth (with a Dacron strap) that could be slid into the socket (between
the hook and liner) to keep them apart during the donning/doffing.
Good luck.
Jonathan Naft, C.P.
----------------------------------------------------------------------------------------------------------------------------------------------------
Ted, we have all been there. I would have a talk with him, and if his old
style socket that is working just needs a bit more room, or upgrade without
disturbing anything else, or if you can make some beneficial change without
being radical that may be as good as it gets. Obviously this is going to
drive you crazy with the patient being out of town, and your under the gun
sort of speak. The reality probably is that he / she has compensated for
the socket design with gait anomallies your not even going to believe, if
you were able to note all of them down. Yes, there probably is a solution,
but it just may not be a 100% solvable this time around. Granted Ted I am
taking your experience into consideration. Part of the success for our
profession comes in the package that the surgeon hands us, you have to work
with what you have, not with what you wish it was. Sincerely, Richard L.
Feldman, CPO
----------------------------------------------------------------------------------------------------------------------------------------------------
Perhaps the Harmony system would work. With a Hypobaric sheath it would
slide in well and then be held in volume and rotation under full
vacuum. Jack Ullendahl fits them and I am working on one right now.
Lane Ferrin CP
----------------------------------------------------------------------------------------------------------------------------------------------------
Responses are continued in next message.
Ted A. Trower C.P.O.
A-S-C Orthotics & Prosthetics
Jackson, Michigan, USA
www.amputee.com
********************
To unsubscribe, send a message to: <Email Address Redacted> with
the words UNSUB OANDP-L in the body of the
message.
If you have a problem unsubscribing,or have other
questions, send e-mail to the moderator
Paul E. Prusakowski,CPO at <Email Address Redacted>
OANDP-L is a forum for the discussion of topics
related to Orthotics and Prosthetics.
Public commercial postings are forbidden. Responses to inquiries
should not be sent to the entire oandp-l list. Professional credentials
or affiliations should be used in all communications.
Citation
Ted Trower, “difficult AK fitting Response summary Part 1,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 2, 2024, https://library.drfop.org/items/show/221710.
