RESPONSES: Thigh lacer alternative for humid conditions
Anna Frazer
Description
Collection
Title:
RESPONSES: Thigh lacer alternative for humid conditions
Creator:
Anna Frazer
Date:
10/7/2007
Text:
RESPONSES SUMMARY:
I received many responses to my request regarding thigh lacer
alternatives for humid conditions and valgus control for a transtibial
amputee with spina bifida. By and large, most people advised against
leather due to the heat and mould issues in humidity and the following
options were suggested:
· Ventilated thermoplastic or laminated thigh lacer/shell with
Velcro or buckle closure
· Canvas covering for thigh section, removable for washing
· Single lateral upright with proximal band and cuff, and knee
spyder
· Knee orthosis attached to prosthetic socket, permanently or
removable for servicing
· Removable medial wedge
· Eliminating the silicone liner due to excessive sweating and
unavailability of maintenance/replacements
· Extending the silicone liner to encompass the thigh
If we retain the silicone liner and clutch lock, then a single upright
or KO design will be functional with minimal skin contact, as suspension
will not be required. However, the availability of prosthetic services
in PNG is unknown, so a more robust design and eliminating silicone and
clutch lock may be necessary- unless the pt opts to return to Australia
for prosthetic maintenance.
Many thanks to all who responded (for detailed responses see below),
and I*m sure that we will come up with a solution that meets the
patient*s needs.
Regards,
Anna Frazer
Prosthetist.
-------------------------------------------------------------------------
Have you considered a thermoplastic thigh lacer instead of the typical
leather? It could be ventilated to allow some air to circulate. This
would require casting the thigh as you would for a KAFO, but would be
less susceptible to perspiration breakdown/rot as well.
-------------------------------------------------------------------------
Just be honest with the patient. She sounds very active for all her
handicaps. Tell her the truth and stick by your guns. You should
consider a high density ethylene for the thigh lacer, or a washable
heavy boat canvas that can slide over the thigh joint bars so it can be
washed.
-------------------------------------------------------------------------
It sounds as if a laminate corset would be a good alternative to a
leather thigh lacer. Your patient would be able to continue with the
current suspension method and reduce the surface area normally covered
by a leather lacer.
The laminated corset also prolongs the life of the joints. This type
of corset would provide the needed stability and also facilitate
donning.
-----------------------------------------------------------------------------------
We have successfully used COPLY for a thigh lacer. I*ll explain:
1. Make a mold of the residual limb to include the thigh up to the
area you want in the lacer, modify the mold as normal.
2. Mount a set of Okalahoma Style Orthotic Ankle joint over the
anatomical knee center on the mold.
3. Pull ** COPOLY over the entire mold (apply any interface
preferred first) and seam the COPOLY either anterior or posterior
depending on whether you want the lacer anterior or posterior ( I prefer
an anterior lacer with 2* Velcro posterior for cooler thigh plus you
can ventilate the shell).
4. Trim as you would for you normal B/K but you must leave enough
clearance for knee flexion. Trim the joints as per instructions
------------------------------------------------------------------------
You can try casting the patients thigh and mold a polypropelene thigh
cuff and use dacron staps with buckles for closures. I usually use
velcro, but, the patient may have trouble replacing it out in the
bush. Polypro is strong enough that you can ventilate it generously
and it will still hold the patient.
-----------------------------------------------------------------------------------
If your patient is wearing a silicone liner, I would increase the
length of that up on to the thigh and do a laminated thigh section or
some other material besides leather. I am a short T/T and wear an Alpha
liner to the top of my thigh and have a laminated thigh section attached
to Otto Bock joints. I've never really felt there were any heat related
issues and I think the liner actually helps that vs. skin and sock in a
KAFO. I think the benefits of stability with the joint and corset will
greatly outweigh any sweat and heat issues, at least that's my personal
view. Hope that helps!
------------------------------------------------------------------
I agree you need to go above knee for support, but I differ in that I
would make a single lateral upright using a modified knee spyder to
achieve valgus correction off the lateral bar.Since patient is not
dependent on joint/lacer for suspension or weight bearing the single
upright should do nicely. This design eliminates the full encompassing
of thigh, you only need a narrow proximal thigh band with cuff, 1-1/2 or
2 inch wide is sufficient. Since pt is moving to boondocks I would opt
for heavier bar and joint, polycentric?, for durability. I had a symes
with similar problem, worked well. Hope this helps.
-----------------------------------------------------------------------------------
If the thigh section is going to be used for M-L control Why use a full
thigh lacer instead use a prox. thigh band & cuff
------------------------------------------------------------------
Certainly Thigh lacer is best option to control valgus,, instead of
silicone liner, try pure cotton thigh stockinette,it should work out
fine in humid atmosphere.
INDIA
---------------------------------------------------------------------
You might try a removable medial wedge to create a supracondylar type
socket. This will help control the medial-lateral movement if the knee.
Not as effective as a thigh lacer but there will be improvement. Also
try adjusting the alignment to reduce this motion i.e.: insetting or out
setting the foot.
-------------------------------------------------------
I recently fit a similar prosthesis to a man with a very short TTA
resulting in general M-L instability and recurvatum. The prosthesis
consisted of a thin (~4 nyglass, 1 fiberglass) inner shell with a hole
cut out distally so his locking liner could reach through to the shuttle
lock in the lower section. Over the thin laminated shell, I contoured a
Bledsoe Axiom KO (off the shelf, selected Axiom because it is easily
disassembled for fabrication) to the limb shape. Using pedelin foam, I
filled in sharp contours to allow inner shell and KO to be removed from
the outer prosthesis. After this, I pulled a PVA bag over the shell and
KO and laminated a standard socket with shuttle lock and 4-hole
attachment.
Once complete, the brace provided sufficient M-L support and genu
recurvatum control and was removable for repair or short-term use
without the orthosis. As we had no need to unload the limb, a lacer
wasn't necessary. Also, all straps except the most proximal were
unnecessary which helped with keeping him cool.
-----------------------------------------------------------------------------
Townsend can make a knee orthosis fit over a prosthetic socket.
-----------------------------------------------------------------------------
why not to attach a knee brace to the socket instead? you can make it
yourslef or have someone fab it for you. as cool as it gets, and you can
make it look pretty. one of our local prosthetists did a very smart
thing - he made a KO with horton knee hinge in it for a very short TTA
patient. i was present at the presentation, VERY radical difference in
ambulation. then he just billed for the stance controlled knee. depends
on what you use for the knee joint. OTS
- you need to talk to either tim pereira ot jarret - has a very cool
prototype knee joint, with small hydraulic cylinder attached, very
similar in function to mauch unit. very. controlled flexion/extension,
locking feature, plus extension assist.
-----------------------------------------------------------------------------------
Silicone liners are not used here in sri lanka and I would say probably
not in PNG. Are you going to be sending supplies to her? She will
probably not have access to a prosthetist that has used one before,
which may be concerning if she were to have a problem with the lock.
How long is she going for? Is she planning on going home regularly for
P&O care?
Mostly just the usual pelite liners used here and in Kiribati just
because everything else is too expensive and usually less durable.
How much of the stump is scarred? Could you perhaps put silicone pads
(or similar) over the scared area within a pelite liner? Maybe then you
could give her a supply of silicone pads?
You could use a plastic shell (like KAFO thigh section) with a couple
of wide straps. Maybe then you could even put a few holes in it for
ventilation? or could you do a fancy laminated shell? I guess this
depends on how much you need to take weight off the stump or is the
thigh lacer only required for the valgus?
Leather gets mouldy quite quickly in humid climates and parts rust
really quickly if they are not stainless steel or titanium. I'm
imagining PNG is similar to Kiribati.
-----------------------------------------------------------------------------------
my only comment is that a leather thigh lacing corset will breath
better than her ( i presume p/p kafo) she should understand that the
same control is required over the knee joint as there was before
amputation as that situation has not changed since amputation......you
must protect the knee joint at all costs to prevent future serious joint
problems..
You just have to explaint the senario to her and get her to accept the
need.
END OF RESPONSES
I received many responses to my request regarding thigh lacer
alternatives for humid conditions and valgus control for a transtibial
amputee with spina bifida. By and large, most people advised against
leather due to the heat and mould issues in humidity and the following
options were suggested:
· Ventilated thermoplastic or laminated thigh lacer/shell with
Velcro or buckle closure
· Canvas covering for thigh section, removable for washing
· Single lateral upright with proximal band and cuff, and knee
spyder
· Knee orthosis attached to prosthetic socket, permanently or
removable for servicing
· Removable medial wedge
· Eliminating the silicone liner due to excessive sweating and
unavailability of maintenance/replacements
· Extending the silicone liner to encompass the thigh
If we retain the silicone liner and clutch lock, then a single upright
or KO design will be functional with minimal skin contact, as suspension
will not be required. However, the availability of prosthetic services
in PNG is unknown, so a more robust design and eliminating silicone and
clutch lock may be necessary- unless the pt opts to return to Australia
for prosthetic maintenance.
Many thanks to all who responded (for detailed responses see below),
and I*m sure that we will come up with a solution that meets the
patient*s needs.
Regards,
Anna Frazer
Prosthetist.
-------------------------------------------------------------------------
Have you considered a thermoplastic thigh lacer instead of the typical
leather? It could be ventilated to allow some air to circulate. This
would require casting the thigh as you would for a KAFO, but would be
less susceptible to perspiration breakdown/rot as well.
-------------------------------------------------------------------------
Just be honest with the patient. She sounds very active for all her
handicaps. Tell her the truth and stick by your guns. You should
consider a high density ethylene for the thigh lacer, or a washable
heavy boat canvas that can slide over the thigh joint bars so it can be
washed.
-------------------------------------------------------------------------
It sounds as if a laminate corset would be a good alternative to a
leather thigh lacer. Your patient would be able to continue with the
current suspension method and reduce the surface area normally covered
by a leather lacer.
The laminated corset also prolongs the life of the joints. This type
of corset would provide the needed stability and also facilitate
donning.
-----------------------------------------------------------------------------------
We have successfully used COPLY for a thigh lacer. I*ll explain:
1. Make a mold of the residual limb to include the thigh up to the
area you want in the lacer, modify the mold as normal.
2. Mount a set of Okalahoma Style Orthotic Ankle joint over the
anatomical knee center on the mold.
3. Pull ** COPOLY over the entire mold (apply any interface
preferred first) and seam the COPOLY either anterior or posterior
depending on whether you want the lacer anterior or posterior ( I prefer
an anterior lacer with 2* Velcro posterior for cooler thigh plus you
can ventilate the shell).
4. Trim as you would for you normal B/K but you must leave enough
clearance for knee flexion. Trim the joints as per instructions
------------------------------------------------------------------------
You can try casting the patients thigh and mold a polypropelene thigh
cuff and use dacron staps with buckles for closures. I usually use
velcro, but, the patient may have trouble replacing it out in the
bush. Polypro is strong enough that you can ventilate it generously
and it will still hold the patient.
-----------------------------------------------------------------------------------
If your patient is wearing a silicone liner, I would increase the
length of that up on to the thigh and do a laminated thigh section or
some other material besides leather. I am a short T/T and wear an Alpha
liner to the top of my thigh and have a laminated thigh section attached
to Otto Bock joints. I've never really felt there were any heat related
issues and I think the liner actually helps that vs. skin and sock in a
KAFO. I think the benefits of stability with the joint and corset will
greatly outweigh any sweat and heat issues, at least that's my personal
view. Hope that helps!
------------------------------------------------------------------
I agree you need to go above knee for support, but I differ in that I
would make a single lateral upright using a modified knee spyder to
achieve valgus correction off the lateral bar.Since patient is not
dependent on joint/lacer for suspension or weight bearing the single
upright should do nicely. This design eliminates the full encompassing
of thigh, you only need a narrow proximal thigh band with cuff, 1-1/2 or
2 inch wide is sufficient. Since pt is moving to boondocks I would opt
for heavier bar and joint, polycentric?, for durability. I had a symes
with similar problem, worked well. Hope this helps.
-----------------------------------------------------------------------------------
If the thigh section is going to be used for M-L control Why use a full
thigh lacer instead use a prox. thigh band & cuff
------------------------------------------------------------------
Certainly Thigh lacer is best option to control valgus,, instead of
silicone liner, try pure cotton thigh stockinette,it should work out
fine in humid atmosphere.
INDIA
---------------------------------------------------------------------
You might try a removable medial wedge to create a supracondylar type
socket. This will help control the medial-lateral movement if the knee.
Not as effective as a thigh lacer but there will be improvement. Also
try adjusting the alignment to reduce this motion i.e.: insetting or out
setting the foot.
-------------------------------------------------------
I recently fit a similar prosthesis to a man with a very short TTA
resulting in general M-L instability and recurvatum. The prosthesis
consisted of a thin (~4 nyglass, 1 fiberglass) inner shell with a hole
cut out distally so his locking liner could reach through to the shuttle
lock in the lower section. Over the thin laminated shell, I contoured a
Bledsoe Axiom KO (off the shelf, selected Axiom because it is easily
disassembled for fabrication) to the limb shape. Using pedelin foam, I
filled in sharp contours to allow inner shell and KO to be removed from
the outer prosthesis. After this, I pulled a PVA bag over the shell and
KO and laminated a standard socket with shuttle lock and 4-hole
attachment.
Once complete, the brace provided sufficient M-L support and genu
recurvatum control and was removable for repair or short-term use
without the orthosis. As we had no need to unload the limb, a lacer
wasn't necessary. Also, all straps except the most proximal were
unnecessary which helped with keeping him cool.
-----------------------------------------------------------------------------
Townsend can make a knee orthosis fit over a prosthetic socket.
-----------------------------------------------------------------------------
why not to attach a knee brace to the socket instead? you can make it
yourslef or have someone fab it for you. as cool as it gets, and you can
make it look pretty. one of our local prosthetists did a very smart
thing - he made a KO with horton knee hinge in it for a very short TTA
patient. i was present at the presentation, VERY radical difference in
ambulation. then he just billed for the stance controlled knee. depends
on what you use for the knee joint. OTS
- you need to talk to either tim pereira ot jarret - has a very cool
prototype knee joint, with small hydraulic cylinder attached, very
similar in function to mauch unit. very. controlled flexion/extension,
locking feature, plus extension assist.
-----------------------------------------------------------------------------------
Silicone liners are not used here in sri lanka and I would say probably
not in PNG. Are you going to be sending supplies to her? She will
probably not have access to a prosthetist that has used one before,
which may be concerning if she were to have a problem with the lock.
How long is she going for? Is she planning on going home regularly for
P&O care?
Mostly just the usual pelite liners used here and in Kiribati just
because everything else is too expensive and usually less durable.
How much of the stump is scarred? Could you perhaps put silicone pads
(or similar) over the scared area within a pelite liner? Maybe then you
could give her a supply of silicone pads?
You could use a plastic shell (like KAFO thigh section) with a couple
of wide straps. Maybe then you could even put a few holes in it for
ventilation? or could you do a fancy laminated shell? I guess this
depends on how much you need to take weight off the stump or is the
thigh lacer only required for the valgus?
Leather gets mouldy quite quickly in humid climates and parts rust
really quickly if they are not stainless steel or titanium. I'm
imagining PNG is similar to Kiribati.
-----------------------------------------------------------------------------------
my only comment is that a leather thigh lacing corset will breath
better than her ( i presume p/p kafo) she should understand that the
same control is required over the knee joint as there was before
amputation as that situation has not changed since amputation......you
must protect the knee joint at all costs to prevent future serious joint
problems..
You just have to explaint the senario to her and get her to accept the
need.
END OF RESPONSES
Citation
Anna Frazer, “RESPONSES: Thigh lacer alternative for humid conditions,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 1, 2024, https://library.drfop.org/items/show/228685.
