Presentation on theme: "Department of Orthotics and Prosthetics"— Presentation transcript:
1Department of Orthotics and Prosthetics Below Knee prosthesisDepartment of Orthotics and ProstheticsprosthesisMahmood Bahramizadeh
2HistoryThe earliest recorded use of a limb prosthesis is that of a persian soldier, Hegesistratus. (Herodotus).The oldest known artificial limb in existence was a cooper and wood leg. 300B.C.
3Partial foot amputation Vascular disorders and trauma are the major causes of lower limb amputation.Prediction of healing is the most important part of level selection.As a general rule, all length possible should be saved.
4Types of prosthesis Postoperative pros. Initial pros. Preparatory pros.Definitive pros.Special use pros.
5Postoperative pros Provided within 24 hours of amputation. Most commonly prescribed for the younger, healthier individual.Acronyms:IPSF: immediate postsurgical fitting.IPOP: immediate postoperative prosthesis.
6Initial pros. Provided as soon as the sutures are removed. Due to the usual rapid atrophy of the residual limb, is generally directly molded on the residual limb by using plaster of paris or fiberglass bandage.Acronyms:EPSF: early postsurgical fitting.
7Initial pros.1 to 4 weeks after amputation. Until the suture line is stable and the skin can tolerate the stresses.
8Preparatory pros.Used in cases to assess ambulatory or rehabilitation potential and help clarify details of the prosthetic prescription.Used a few days following suture removal.Lacks the protective and cosmetic.It used until stump matures.Used to optimize alignment.Used 3 to 6 months following the date of amputation.
9Preparatory pros.Amputees may wearing ten plies of prosthetic socks to compensate for atrophy.
10Definitive pros.Residual limb has stabilized to insure that the fit of the new prosthesis will last as long as possible.The average life span for a definitive prosthesis is from 3-5 years.
11Special use pros.A certain number of patients will require for such activities as swimming, skiing.
23ProsthesisThe break is an ordinary shoe is at the metatarsophalangeal joints.The vamp of the shoe may irritate the top of the stump, resulting in sores.Adding the steel spring between inner and outer sole.
24Prosthesis Adding a rocker bottom. Without support in the front of the bottom the patient will display a limp as walking speed increases.
35ProsthesisBoot with toe filler: nothing to improve the gait over walking barefooted.Rub the end of the stump, causing pressure and ulceration.
36Prosthesis Boot with semirigid metal sole and toe filler: From mid-stance until toe-off a long steel spring shank assists push-off by resisting the forces acting to dorsiflex the forefoot.
37Prosthesis A.F.O: A posterior leaf spring AFO. Resistance to plantar flexion at heel strike.Allowing a slow descent of the foot.Resist dorsiflexion and assist push-off from mid-stance to toe-off.
38Prosthesis Chopart prosthesis: is almost identical to the syme prosthesis in fabrication.Unlike the syme amputation, there is no distance between the end of the residual limb and floor with the chopart.
39Pirogoff amputation Calcaneal fragment-tibia arthrodesis End-bearing stump.Advantages:End-bearingWalk with less limpThe heel flap does not wobble as it may do on the syme limb.
40Prosthesis Shoe filler. Thick shoe sole with soft padding PLS AFO PUSH OFF IS LOSTThick shoe sole with soft paddingPLS AFO
42Syme Ankle disarticulation. The advantages of the Syme over below knee amputation:Decreased risk of serious hemorrageDecreased mortalityA more comfortable limbA more useful limb for W.Bearing.Function is enhanced by limb length.
43SymeBilateral syme amputee walk with a better gait and can stand longer than bilateral below knee.Phantom Pain is rare after a syme amputation.
45ProsthesisThe syme amputation has had only limited popularity until recently, at least in part because of the difficulty of providing a suitable prosthesis.Syme pros. Should have durability especially in the ankle region.
47Historic syme pros. Front lacing leather socket. Strong steel frame forms medial and lateral uprights that reinforce the leather.The tightness of the the thigh-lacer provides a means of adjusting the relative distribution of weight bearing between the proximal and distal aspects of the limb.
48Historic syme pros. A single-axis joint. Uncosmetic Heavy Used in countries where plastic laminates are unavailable.
49Canadian syme pros.A posterior door that extends to the brim of the socket allows insertion of the limb and then is bulked into place into place for closure.
51Veterans administration syme pros. Medial window.Enhances the mechanical strength of the prosthesis over the canadian syme.Some weight bearing occurs along the proximal trim lines.Casting at 10 degrees flex.
52Veterans administration syme pros. Suspension:Circumference proximal to the bulbous end.Auxiliary suspension: femoral condyle strap.
62Multiple axis (functional) ankle Articulated assembleCable: flexible cable between the foot and shank. Movement occurs in any direction.Otto bock universally movable GreissingerNon Articulated assembleSolid ankle cushion heelPost operative flat heeled footLitefootVeterans administration/ kingsley Beachcomber footStationary attachment flexible endoskeletal (SAFE)
63Articulated assembles Mediolateral and torsional forces are reduced (absorption).Accommodates well to uneven ground.Less cosmetic than single and SACH
64Articulated assembles Otto bock Greissinger foot:Can be used for above knee and below knee.More cosmetic and lighter in weight than cable.
65Non articulatedSACH:Shock absorption and motion provided by the material and structure.
66Non articulated Heel wedge compresses at heel strike The shape and length of the wooden keel provide the smooth rocker motion and support.Foam rubber sole and nylon belting resistance to toe extension.External keel provide more stability than internal keel.
67SACHThe arch should provide at least 0.3 cm (1/8 in) clearance between the foot and shoe.The lower third of the SACH foot heel should fit snugly into the heel counter.
71Variations of the SACH Sculptured toe SACH foot: In various heel height and firmnesses
72Non articulated Post operative flat heeled foot; For immediate prosthesisGood lateral stabilityThe weight 20 percent less than the regular molded foot.Resistance to the toe break is less than standard SACH.Used for swimming and water skiing.Used with flat heeled shoes such as tennis shoes.
73Non articulated Lite foot: Lighter and softer than the regular SACH For early ambulation and for a definitive porsthesis.
74Non articulated Veterans administration/kingsley Beachcomber foot: WaterproofCan locks at 120 degrees for swimming.
76Non articulated Stationary attachment flexible endoskeletal (SAFE): Like windlass effectAt heel off the bands tithens to create a semirigid toe lever.Flexible keel is used to adapt in irregular surfaces.Long plantar ligament band span the arch to stabilize that when wearer stand.
77Non articulatedThe anterior surface of the Bolt Block is cut at 50 degrees and the inferior surface is rounded to provide a subtalar- like surface.It has no mechanical joint.
78Axial rotation deviceThis device is used to absorb the torque and shearing force and provide the wearer to be safe of skin abrasion and allows the socket to rotate independently of the foot position.
79Advantages of B.K as opposed to A.K Mortality is lower.Much better prospect of prosthetic rehabilitation.Phantom limb is lower.
81Prosthesis Historic below knee: Consists of a leather thigh corset + side bars+ open ended socket.Weight bearing is carried on the residual limb and through the suspension mechanism.
82Historic below knee (advan.) The thigh corset supports some of the weight bearing.Prevent hyperextension at the knee.Provides lateral-medial stability.The socket is cooler than the total contact PTB because of lack of total contact pressure.
83Historic below knee (disadvanta.) EdemaBulky and heavilyUncosmeticAtrophyRelative motion causing irritation.IschemiaThe hinge breaks frequently.No normal gait.
84Slip socketDesign to minimize relative motion between the socket and skin.The socket is either elastically suspended from the sidebars or is attached to shank by a compression spring.The socket can rotate and piston up and down.
85Slip socketIs used for only for those people with short or tender limb.
86Slip socket Advantages: The amputee with the slin graft can ambulate early.It preserves the knee joint.
87Slip socket Disadvantages: Uncosmetic. Bulky and heavy Produce atrophy.Tear of clothing.Walk more like an A.K amputees.
88P.T.B Was developed at the university of california (1959). More intimate fit and more efficient than historic.
89P.T.B Advantages: Total contact design. Improve circulation Prevent edemaTo distribute the W.B.Better proprioception.
90P.T.B Lighter than the historic. More freedom of movement than the thigh corset.More cosmetic gait.Gait looks ssentially normal except for the lack of push off.
91P.T.B More cosmetic. Easier to don and remove. Require less time for fabrication.
92P.T.B DisAdvantages: Require more critical fit Excessive perspiration There is a tendency for the amputee to hyperextend the knee.Frequent readjustments may be necessary.
93ShankConnect the ankle/foot assembly with the socket in a specific alignment.
97Posterior brimThe posterior brim is generally 0.6 to 1.3 cm (1/2 to ¼ in) higher than the patellar shelf tendon shelf.For very short limbs the posterior brim may be so high that flexion is limited to 60 degrees.
101Anterior brimThe anterior brim comes to the midpatellar level.
102Medial and lateral brim M-L brims come to about the level of the proximal edge of the patella.The proximal aspect of the medial and lateral walls support the femoral condyles and are usually 6.5 cm (2.5in) above the medial tibial plateau in height.
104Hard socket The hard socket may or may not have a distal pad. Advantages:Less problem with perspiration.Easy to cleanLess bulk at kneeFabrication time is lessMore intimate fit than with an insert.Disadvantages:More difficult to fitLess adjustability
105Soft insert socketSoft inserts are used between the hard socket and the limb.Advantages:Less difficult to fitPossible added comfortCan make donning easier
106Soft insert socket Disadvantages: Hot Poor hygiene More weight Some sacrifice of stability.
107Ultralight below knee A completely crustacean PTB Exoskeletal type can be much lighter in weight while providing the same strength.The outer structure is farther from the axis and thus has a longer lever arm.
108Ultralight below knee Socket: P.P Is vacuume-formed. Foot: A sole and heel cushion like that used with any SACH can be used for itWaterproof: the presence of buoyancy causes a problem during swimming
109Ultralight below knee Advantages: Require less energy to walk. Less pistoningCan be worn in and around water
110Ultralight below kneeDisAdvantages:Not durableDefficult to modify
111Bent- knee prosthesisIs used in cases of irreducible knee flexion contractures.A plaster negative is made of entire limb from well up on the lower third of the femur with the knee joint in maximum extension.
112Bent- knee prosthesis External knee joint Weight is borne through the remaining portion of the tibia, patellar tendon, thigh cuff.Durablecheap
113Bent- knee prosthesisIs required because of poor skin condition, limited weight bearing capability, or limited knee function.
114Cuff suspension Suspends the prosthesis during swing phase. Checks against knee hyperextension.
115Cuff suspension Atrophy does not occur. Does not create relative motion.Not bulky.More cosmetic.
116Cuff suspension Does not give M-L stability. Uncosmetic when sitting Positioning of studs is critical.
117Forks, jack, or inverted Y strap to a waist belt Is used for disvascular amputee.When hip is extended and the knee is flexed during walking, the fork is under tension and acts to extend the knee and bring the shank forward.
118Forks, jack, or inverted Y strap to a waist belt Good auxiliary suspension.Uneven suspension through swing phase.
119Suspension prosthesis (PTS) Sc/sp . Pts: prosthese-tibiale-supracondylienne.Better M_L stability.The patellar shelf is less pronounced in the PTS than in the PTB.
120Suspension prosthesis (PTS) Sc/sp . For short stump: <7.5cm.Knee instability due to lig. And muscle dysfunction.
121Suspension prosthesis (PTS) Sc/sp . Less restrictive.Easier to don.Prevents genu recurvatum.More cosmetic.
122Suspension prosthesis (PTS) Sc/sp . The prosthesis tend to slip down when the knee is flexed 90.Patellar enclosure may inhibite extreme knee flex.Is not suitable for long stump.Difficult for obese limb.