Re: "Ask the Ertls " Special Instructions for Prosthetists In Fitting a Ertl Limb

Re: "Ask the Ertls " Special Instructions for Prosthetists In Fitting a Ertl Limb

Tony Barr

1/11/2007

Special Instructions to CPs fitting Ertl Amputees?






Q: From Kristi

 

General Topic:

Special Instructions to CPs fitting Ertl Amputees?

 

 

 

I don't find any documents on the website of the proper method of fitting an
Ertl amputee with a socket.

 

Unfortunately, I don't have the luxury of traveling to see an experienced
Ertl prosthetist, and am having a real problem with my socket fitting
comfortably. I have constant swelling and pain at the knee, the bone on the
outside of my leg (tibia head?), and my shin bone.

 

Jonathan Day, Prosthetist in Oklahoma, gave my prosthetist specific
directions to put pressure at the end of my limb when making the mold for my
socket. My prosthetist did this for the first test socket. Now, he just
puts the plaster on, smoothes it down and lets it dry. He hasn't put
pressure at the end the last 3-4 sockets. Is putting pressure at the end of
my limb and pushing it up an important step in making a socket for an Ertl
amputee? If so, why?

 

Also, my prosthetist makes my sockets so that I'm bearing a lot of weight
under my knee, which causes pain. I'm bearing some weight at the end, but I
don't think it's enough. I told him I got the Ertl amputation so that I
could bear weight. Every time I go in to see him, I ask him to shave down
the socket at the knee, because the pain it causes is unbearable for me. He
balks at it, but does it for me anyway. Because of this, I believe my limb
sinks down deeper into the socket, which is what I want and it feels fine at
the end of my limb, but the rest of my leg seems to be suffering. Could it
be that when my leg sinks down, it's causing my shin, tibia head and knee
to fall into a different position in the socket than what was originally
molded for these bones, causing pressure, swelling and pain in these areas,
because he did not form fit the socket to allow for weight bearing?

 

I just paid $11,500 for a new prosthesis, which has a Renegade foot.
Unfortunately, I can't wear it much due to my socket discomfort. Not only
that, I'm having pain in my sound foot, due to overcompensation. So, I need
to do something to correct this problem, but can't seem to get it done.

 

Just wondering if someone can offer some advice I can pass on to my
prosthetist. I'm ready to get on with my life and my sockets are keeping me
from that. My limb is long, about 7 inches from the knee and I'm wearing a
hard plastic socket.

 

Thank you for any help and advice and I hope this makes sense!



A: From Dr W. Ertl

The goal of fitting an Ertl amputee, in general, is to provide them with an
end-bearing, maximal surface bearing socket to maximize the capabilities of
end-bearing that the residual limb can sustain. Every patient is unique in
terms of shape of the limb, volume of the limb and stability of the soft
tissues. It will take some experimenting, trial/error, with an inexperienced
prosthetist to obtain this. I would defer specific instructions to
prosthetists who a significant experience with Ertl amputees.

 

A socket designed for a patient who has had the benefit of an Ertl style of
amputation should be, and in my opinion, must be of a total surface weight
bearing design. Dr. William Ertl wisely makes mention of this in his
comments above. The length of the socket as measured from the Patella Tendon
bar to the distal end of the socket is quite critical. While I use a mild
(straight not smiley face shape) Patella Tendon bar in the socket I do not
rely on, or intend the bar to be a major weight bearing area. Nor do I
expect the bar to prevent the patient from going lower in the socket as
they experience volume loss. In a total surface weight bearing socket the
residual limb is supported evenly throughout the entire socket. As the
patient experiences some volume changes in their daily activities, they just
begin to have a little more weight bearing on the distal end. This is not
distressful to the patient as their surgery was designed to accommodate this
and most of them will tell you that they just feel a little looser in their
socket and a little firmer on the distal end towards the end of the day.
Because there is no place in the socket for them to go, the shape of their
residual limb continues to match the shape of the socket. If they do not
have good distal contact and they begin to have some volume loss throughout
the day then their skeletal structure begins to be forced down into a part
of the socket that does not match their anatomical shape. The following
result is usually pain. I suspect that may be happening to this patient.
However, without seeing the patient, this is only my best GUESS.As a side
bar, I would humbly suggest that the patient ask her prosthetist to either
make her a socket that she can wear comfortably or return the fees that she
paid him for those services. It is like buying a new car. If it doesn't
work the place that you bought it needs to either fix it; replace it or give
you your money back. It seems to me that this would not be an unreasonable
request.
 
Respectfully Raymond Francis LPO
 
ErtlReconstruction.com is a website operated/maintained by Ertl procedure
amputees, as well as supporters of the procedure. The included information
concerning the current practicing Dr. Ertl(s) and the growing list of
physicans performing the procedure, is done out of respect for them and to
honor the memories of Janos Ertl, Sr. (the originator of the Ertl Procedure)
and William G. Barr, one of thousands of Ertl recipients and avid advocate
for the proper surgical care for the amputee.

 
 
Anthony T. Barr
President
Barr Foundation
www.oandp.com/barr
 < <URL Redacted>> www.ErtlReconstruction.com