Re: What special qualifications do Prosthetists have to have to fit Ertl Limbs and how do I get listed?
Tony Barr
Description
Collection
Title:
Re: What special qualifications do Prosthetists have to have to fit Ertl Limbs and how do I get listed?
Creator:
Tony Barr
Date:
6/16/2006
Text:
I see a number of prosthetists listed on your site as Ertl Prosthetists.
What special qualifications do these people have that other prosthetists do
not? How does one become an Ertl Prosthetist?
Warren Mays, CPO
Sent on Behalf of Raymond Francis LCP as reply to submision and posted to
Ertl Reconstruction.com 'Ask the Ertls link.
Here is my attempt to clarify the things that a Prosthetist needs to know
that is working with patients who have the good fortune to have received
surgery as described by Ertl from those who have not. Since there is
nothing being done in the schools that teach Prosthetists how to care for
and manage amputees that have had their surgery done as recommended by Ertl,
it becomes incumbent for the Prosthetist to learn on his/her own about the
principals involved with this procedure.
First the Prosthetist must have a very clear understanding of the principles
of a Total Surface Weight Bearing Socket. It does not matter if the patient
is a Transtibial or Transfemoral amputee. The very strict principals of
Total Surface Weight Bearing must be adhered to. I would like to point out
as a lecturer to many Prosthetists that have come to our facility to attend
seminars here there is a vast amount of confusion over the difference
between the definition of Total Contact and Total Surface Weight Bearing.
Let me try and clear up that point right now. The difference between the
two terms is that a Total Contact socket touches the residual limb in all
places but still indicates that there are areas of weight bearing and
areas where there is skin contact but NO weight bearing. The Total Surface
Weight Bearing socket is designed to distribute the patient's weight EVENLY
throughout the entire socket. There should be no areas that carry more of
the patient's weight then any other area. This is very important to the
transtibial amputee.
In prosthetics that are made for traditional amputations where the Ertl
recommendations are not followed there is significantly more weight
bearing carried at the proximal portion of the socket. The attempt is to
prevent the patient's residual limb from bearing any weight against the
distal circumference as well as directly on the end of the tibia or fibula.
These areas are usually very sensitive and painful to any type of
compression. The fibula does not respond well to any pressure that tends to
direct the bone medially causing pain from the squeezing of the muscles and
nerves that are between the tibia and the fibula. All Prosthetists are
taught during their training years about this issue and the best way to
manage it. In transtibial amputations that are done following the Ertl
recommendations this problem does not exists. Since the tibia and fibula
are joined at the distal end by an osteomyoplastic reconstruction procedure
the distance between the two bones does not change and therefore does not
impinge on the muscles and nerves. It is important for the Prosthetist to
know and understand this principle of surgical reconstruction. It is the
Prosthetist that is going to design the socket for this patient and in fact
he needs to establish a stabilizing force along side the reconstructed
fibula. This is exactly the opposite of what would normally be done for the
traditional non-Ertl case.
Prosthetists should follow the example of surgeons. If a surgical procedure
is developed that is different from what is traditionally taught and
practiced in the mainstream of surgery the surgeon wishing to use the new
procedure will read any and all published information on the subject. In
the interest of providing no harm to the patient as well as desiring to have
the most successful outcome for the patient, the non-experienced surgeon
will usually contact the surgeon performing the procedure and they will
communicate back and forth on a professional level. If there are very
intricate and technical procedures involved the experienced surgeon will
often invite the non-experienced surgeon to observe the procedure being done
so he can see first hand some of the subtleties of the surgical techniques.
The Prosthetist that is designing a socket for an amputee that has undergone
a procedure described by Drs. Ertl should have current x-rays of the
patient's residual limb. It is important to see the finished shape of the
tibia and fibula. It is important to see if the edges of both bones are
rounded or if the callous formation may have produced an irregularity in
the healing process. If there are any irregular callous shapes present they
need to be accommodated for the socket design and fabrication. Since the
end goal in mind is for the patient to be able to bear weight equally on the
distal end of the residual limb as they do throughout the entire socket the
design of the shape of the distal portion of the prosthesis is quite
critical. It usually is more square than is seen in the non-Ertl amputee's
socket. Being familiar with the use of x-rays and the information that they
offer the Prosthetist in socket design is often something that is best
learned through instruction from someone that has been there before.
It is highly desirable for the Prosthetist to observe an amputation
preformed using the methods described by Drs. Ertl. This gives insight to
the care that is needed in the first six weeks post surgery. The
Prosthetist plays a very important role in guiding the patient during this
healing process. He/she sees the patient more than any other member of the
rehabilitation team. Whether a rigid or soft dressing is used, the
Prosthetist is really the one who guides the patient during this time of
healing. In that light, the Prosthetist has a serious obligation to ensure
that he/she has gained all the knowledge that is available to assure the
patient is going to have a successful outcome from the surgical/prosthetic
experience. Experienced Prosthetists that have been involved with this
procedure have the same obligation to share and teach other Prosthetist
about their experiences for the benefit of all amputee patients.
Respectfully,
Raymond Francis, L.C.P.
How does one become listed on Ertlreconstruction.com as an Ertl
Prosthetist?
To be eligible to be listed on the Ertl Prosthetic Providers link at
ErtlReconstruction.com, I must be able to have a brief telephone interview
with at least one Ertl amputee you have successfully fitted. Because of
confidentiality laws ,you as a the prosthetist, must ask the patient to
contact me by telephone at 561-394-6514.
It would be ideal, but not mandatory, that the Ertl Amp be at least 30 days
post fitting, be active and have access to e-mail.
Subsequent to a satisfactory interview and qualification, the prosthetist
will submit, upon my direction, his company contact information and web site
address for the listing.Unlicensed /non-certified prosthetists need not
apply.
Tony Barr
Barr Foundation
www.oandp.com/barr
< <URL Redacted>> www.ErtlReconstruction.com
What special qualifications do these people have that other prosthetists do
not? How does one become an Ertl Prosthetist?
Warren Mays, CPO
Sent on Behalf of Raymond Francis LCP as reply to submision and posted to
Ertl Reconstruction.com 'Ask the Ertls link.
Here is my attempt to clarify the things that a Prosthetist needs to know
that is working with patients who have the good fortune to have received
surgery as described by Ertl from those who have not. Since there is
nothing being done in the schools that teach Prosthetists how to care for
and manage amputees that have had their surgery done as recommended by Ertl,
it becomes incumbent for the Prosthetist to learn on his/her own about the
principals involved with this procedure.
First the Prosthetist must have a very clear understanding of the principles
of a Total Surface Weight Bearing Socket. It does not matter if the patient
is a Transtibial or Transfemoral amputee. The very strict principals of
Total Surface Weight Bearing must be adhered to. I would like to point out
as a lecturer to many Prosthetists that have come to our facility to attend
seminars here there is a vast amount of confusion over the difference
between the definition of Total Contact and Total Surface Weight Bearing.
Let me try and clear up that point right now. The difference between the
two terms is that a Total Contact socket touches the residual limb in all
places but still indicates that there are areas of weight bearing and
areas where there is skin contact but NO weight bearing. The Total Surface
Weight Bearing socket is designed to distribute the patient's weight EVENLY
throughout the entire socket. There should be no areas that carry more of
the patient's weight then any other area. This is very important to the
transtibial amputee.
In prosthetics that are made for traditional amputations where the Ertl
recommendations are not followed there is significantly more weight
bearing carried at the proximal portion of the socket. The attempt is to
prevent the patient's residual limb from bearing any weight against the
distal circumference as well as directly on the end of the tibia or fibula.
These areas are usually very sensitive and painful to any type of
compression. The fibula does not respond well to any pressure that tends to
direct the bone medially causing pain from the squeezing of the muscles and
nerves that are between the tibia and the fibula. All Prosthetists are
taught during their training years about this issue and the best way to
manage it. In transtibial amputations that are done following the Ertl
recommendations this problem does not exists. Since the tibia and fibula
are joined at the distal end by an osteomyoplastic reconstruction procedure
the distance between the two bones does not change and therefore does not
impinge on the muscles and nerves. It is important for the Prosthetist to
know and understand this principle of surgical reconstruction. It is the
Prosthetist that is going to design the socket for this patient and in fact
he needs to establish a stabilizing force along side the reconstructed
fibula. This is exactly the opposite of what would normally be done for the
traditional non-Ertl case.
Prosthetists should follow the example of surgeons. If a surgical procedure
is developed that is different from what is traditionally taught and
practiced in the mainstream of surgery the surgeon wishing to use the new
procedure will read any and all published information on the subject. In
the interest of providing no harm to the patient as well as desiring to have
the most successful outcome for the patient, the non-experienced surgeon
will usually contact the surgeon performing the procedure and they will
communicate back and forth on a professional level. If there are very
intricate and technical procedures involved the experienced surgeon will
often invite the non-experienced surgeon to observe the procedure being done
so he can see first hand some of the subtleties of the surgical techniques.
The Prosthetist that is designing a socket for an amputee that has undergone
a procedure described by Drs. Ertl should have current x-rays of the
patient's residual limb. It is important to see the finished shape of the
tibia and fibula. It is important to see if the edges of both bones are
rounded or if the callous formation may have produced an irregularity in
the healing process. If there are any irregular callous shapes present they
need to be accommodated for the socket design and fabrication. Since the
end goal in mind is for the patient to be able to bear weight equally on the
distal end of the residual limb as they do throughout the entire socket the
design of the shape of the distal portion of the prosthesis is quite
critical. It usually is more square than is seen in the non-Ertl amputee's
socket. Being familiar with the use of x-rays and the information that they
offer the Prosthetist in socket design is often something that is best
learned through instruction from someone that has been there before.
It is highly desirable for the Prosthetist to observe an amputation
preformed using the methods described by Drs. Ertl. This gives insight to
the care that is needed in the first six weeks post surgery. The
Prosthetist plays a very important role in guiding the patient during this
healing process. He/she sees the patient more than any other member of the
rehabilitation team. Whether a rigid or soft dressing is used, the
Prosthetist is really the one who guides the patient during this time of
healing. In that light, the Prosthetist has a serious obligation to ensure
that he/she has gained all the knowledge that is available to assure the
patient is going to have a successful outcome from the surgical/prosthetic
experience. Experienced Prosthetists that have been involved with this
procedure have the same obligation to share and teach other Prosthetist
about their experiences for the benefit of all amputee patients.
Respectfully,
Raymond Francis, L.C.P.
How does one become listed on Ertlreconstruction.com as an Ertl
Prosthetist?
To be eligible to be listed on the Ertl Prosthetic Providers link at
ErtlReconstruction.com, I must be able to have a brief telephone interview
with at least one Ertl amputee you have successfully fitted. Because of
confidentiality laws ,you as a the prosthetist, must ask the patient to
contact me by telephone at 561-394-6514.
It would be ideal, but not mandatory, that the Ertl Amp be at least 30 days
post fitting, be active and have access to e-mail.
Subsequent to a satisfactory interview and qualification, the prosthetist
will submit, upon my direction, his company contact information and web site
address for the listing.Unlicensed /non-certified prosthetists need not
apply.
Tony Barr
Barr Foundation
www.oandp.com/barr
< <URL Redacted>> www.ErtlReconstruction.com
Citation
Tony Barr, “Re: What special qualifications do Prosthetists have to have to fit Ertl Limbs and how do I get listed?,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 2, 2024, https://library.drfop.org/items/show/226861.
