2 The APOPPS™ & APOPPS-TF™ by FLO-TECH® O&P Systems, Inc. Robert N. Brown, Sr., CPO, FAAOPCEO/Research, Design & Education
3 Applications in Obesity SetupSelection of Components & MaterialsTrouble shooting
4 APOPPSTM Adjustable PostOperative, Protective & Preparatory System for prosthetic rehabilitation TRANSTIBIAL SYSTEM:The FLO-TECH-TOR™Protective socket or an early (supervised) ambulatory socketThe VCSPS™Protective, PSRD or Preparatory socketThe UFOS™Universal Frame Outer SocketAmbulatory outer socket for both the FLO-TECH-TOR™ and the VCSPS™
5 APOPPS-TM TRANSFEMORAL SYSTEM: The INNER SOCKET The OUTER SOCKET FLO-TECH-TOR-TF™ (Protective), early (supervised) ambulatory or preparatory socketThe OUTER SOCKETUFOS-TF™ (Universal Frame Outer Socket)Ambulatory outer socket
6 APOPPSTM & APOPPS-TF™ Specifics for Obese Patients Systems In Stock:TranstibialAdult 7” & 9” lengthTransfemoralAdult 12” length
7 APOPPS™ & APOPPS-TF™ Sizing The largest TT socket in stock:MPT circumference of 19” to 20”Distal circumference of 16” to 22”The largest TF socket in stock:Ischial circumference of 30”Distal circumference of 22” to 28”Longer or larger requires custom system
8 CUSTOM ORDERS 131 custom sockets provided in 2003 An average of nearly custom sockets per weekAllow 3 lab daysAverage shipping time daysIf ordered before 12 noonAPOPS-KD™ (Knee Disarticulation)
9 Stock BB-d™ Pre-custom Definitive Available in Transtibial & Transfemoral systemsStockCustom sizes
10 Stock BB-d™ Pre-custom Definitive Adjusts circumferentially at all levelsAP adjustability at all levelsML conforms to patient at all levels5 stock sizes2” carved distal end padCustom systems available
11 BB-d™ ORDERS Available in: 5 Transtibial & 3 Transfemoral Stock sizes in left & right configurationsCustom sizesCustom strengthBased on weight & activity levelNon-ambulatory (polypropylene inner socket & Polyethylene outer socket)Up to 500 lbs. (Acrylic resin, carbon & Kevlar inner socket & co-polypropylene outer socket)
13 CUSTOM ORDERS AVAILABLE Toddler, children & youth Transtibial & TransfemoralToddler, children, youth & Knee Disarticulation & SymesNot your every day shapes, sizes and systems for adult, youth, children or toddlers
14 CUSTOM ORDERS PROVIDED Odd shapesExtremely long FLO-TECH-TOR MPT to distal end = 23 ½”plus 1 ½” shrinkage & paddingplus thigh length and trim allowance of 12”Total one piece forming 37”Extremely large TF = 45” Ischial circumference
15 Applying the Socket Attachment Plate Bottom portion of UFOS™ MUST be flatIf not; LIGHTLY sand with a disc sander to remove any protruding plasticAT POINT(S) OF CONTACT ONLY
16 Other UFOS Trim Permitted Suspension wings (A) on the proximal medial & lateral sidesProximal posterior (B); if necessaryNEVER remove material from the distal sides (C)
17 The Socket Attachment Plate The holes in the socket are oversized intentionally and line up with the holes in the Grace plate & the socket attachment plateIf not; carefully drill or cut away any interfering material & smooth as needed
18 Why Over Sized? Rotation – 7o to 10o A & P slide – 1/4” To provide & permitRotation – 7o to 10oA & P slide – 1/4”M & L slide – 1/4”
19 COMPONENTS & OBESITYRating of a complete system is determined by the lowest rated componentThe lower the activity level the higher most components are ratedPylon components rated at 300 lbs with a socket unable to support 300 lbs. plus & an activity level exceeding these limitations negates intended rating
21 COMPONENTSMultiple manufacturers offer choices of: pylon, attachment components & knee units for patients who weigh 275 lbs or less.
22 COMPONENTS Rated to 300 Lbs. HosmerThe W.A.L.K. (Weight Activated Locking Knee) & S.A.F.K (Single Axis Friction Knee) units, Titanium #60794 & #60821The S.A.L.K. (Single Axis Locking Knee) unit #60471All Titanium & Stainless Steel pylon and attachment components in the series #60000
23 COMPONENTS Rated To 300 Lbs. USMCSome Titanium & Stainless Steel pylon and attachment components in the # seriesDesignated by AK and BK respectivelyThe Stainless Steel Knee unit #15226 and the Black Max Knee #P24000 series
24 COMPONENTS Rated To 300 Lbs. Ohio Willow WoodMagnum Heavy Duty SystemFunctional level 4 = 300 lbs.
25 COMPONENTS Rated to 350 Lbs. USMCMachined Titanium pylon and attachment components in the # seriesThe Black Max Short Knee & The ProSport® Titanium Knee in the # series
26 COMPONENTS Rated to 350 Lbs. Ohio Willow WoodMagnum Heavy Duty SystemFunctional level 1-3 = 350 lbs.
27 COMPONENTS Rated to 450 Lbs. IPOS-BauerfeindX-tra Series
28 COMPONENTS Rated to 500 Lbs. TiMED (Titanium Specialists in Prosthetics)BK-500 (does not include foot)GH-610 EX.HD EAR CONNECTOREH-503 TUBE CLAMP 34 mm (requires 2)A mm CARBON TUBEEH-509 EXTRA HD SACH FOOT INSERTUSEHEAVY DUTY SACH FOOTBy Kingsley
29 APOPPS™ Follow Up Concerns Sockets have specific warrantiesWorkmanship and initial qualityThereafter:FLO-TECH-TOR™ 30 daysVCSPS™ 90 daysUFOS™ 90 daysFLO-TECH-TOR-TF™ 90 daysUFOS-TF™ 90 days
30 Follow Up Concerns Hook and Pile Velcro® on the belts are slipping SOLUTIONS:Set belt to patients specifications & stitch all areas in placeYou can remove and discard the double sided hook Velcro®
31 Follow Up ConcernsPatient seems unstable and one or more sockets demonstrate an unwanted medial-lateral motionSOLUTIONS:Practitioner may fine tune alignmentThe toe out and the socket placement over the foot MUST be optimal to minimize unwanted motion
32 Solutions Continued ALIGNMENT SOLUTIONS: Use equally rated offset components if necessaryMaintain alignment whenever removing or disassembling componentsUse pre-custom definitive BB-d if necessary
33 Follow Up ConcernsSwelling is causing skin to protrude through the slots on either side of the FLO-TECH-TORSOLUTIONS:Elevate the limb as often as is practicalBe sure the proper size is usedApply a compressive sock, Ace wrap or liner to the residuum before socket application
34 SOLUTIONS Continued:Add a thin polyethylene tongue to the affected areaAttach the tongue to medial and or lateral areas of the posterior section only
35 Follow Up Concerns Socket or system is difficult to don SOLUTIONS: Apply inner socket & tighten straps and BandsApply a donning sleeve (nylon or parachute material) over the FLO-TECH-TOR, FLO-TECH-TOR-TF or VCSPS (straps, neoprene and all) ANDOpen UFOS™ straps before attempting to insert the inner socket
36 Follow Up Concerns Socket or system is showing signs of stress SOLUTIONS:If FLO-TECH-TOR beyond warranty and patient will move to a new socket soon have patient avoid unsupported ambulation until the new socket is readyIf within warranty call for a Return Authorization number and replacement socket
37 Follow Up Concerns Sockets are rotating one inside the other SOLUTIONS:Be sure sockets are sized appropriatelyDistal sockets are of tri-quad shape to prevent rotationCall for assistance and possible return of socket or system
38 Follow Up ConcernsPatient is slipping up and down inside the socket upon heel contact and toe offSOLUTIONS:Most of this motion is designed into the FLO-TECH-TOR to prevent separation of incision upon early weight bearing and
39 SOLUTIONS Continued: Be sure socks are sized appropriately Be sure all straps and bands are tightened before the UFOS™ is appliedBe sure the waist belt is secured properlyApplication of the Prep Socket (VCSPS™) with other forms of suspension and distal AP closure should eliminate this concern “WHEN THE TIME IS RIGHT”
40 To make the benefits of APOPPS™ technology available to all amputees. COMMITMENTFLO-TECH® O&P Systems is here to assist you in any way we can; please call. Our staff can help with most: fitting, follow-up or adjustment issues.Our Mission is:To make the benefits of APOPPS™ technology available to all amputees.
41 COMMENTARYEach APOPPS™ or BB-d™ prosthesis has the best opportunity for maximum comfort and success if the selection of components conforms to the patients needs and these components are set up, aligned and maintained in the most effective manner.