BY DR.MAJID PG IN ORTHOPAEDICS GANDHI HOSPITAL MODERATOR: DR.RAMESH ASSOCIATE.PROF GANDHI HOSPITAL
BYDR.MAJIDPG IN ORTHOPAEDICSGANDHI HOSPITAL
MODERATOR:DR.RAMESHASSOCIATE.PROFGANDHI HOSPITAL
OrthosisExternally applied mechanical devices support weakened injured, paralyzed, diseased part
“ supplimentation
Prosthesis Device to replace part of the limb or missing limb “substitute”
Prosthetist a person skilled in prosthetics and its application.
Prosthetics: a rehabilitation science includes theory and practice of design, production of prosthesis and application
Aim of prosthesis fitting
• to substitute for a lost part and to restore lost function.
• In the lower extremity prosthesis must permit comfortable ambulation minimal expenditure of energy.
• Reduction of energy requirement
depends on minimizing the shift of the center of gravity of the body during gait
by a well-fitted socket and proper alignment.
But for upper limb:It is difficult to get the function as it
is not possible to replace the “Normal Hand”
center of gravity of the body during gait wheel does not deviate from straight line-hence extreme efficient
Normal human locomotion >2”deviation of CG both horizontally and vertically hence also efficient
Power source of prosthesis
Body powered amputation stump & other limbs .
Externally powered
electric or battery
More distal the amputation more the functional ability ( more natural limb control the prosthesis).
used in the upper limb prosthesis more.
Level of amputation and prosthesis
Toe disarticulation: toe filling rubber,foam,wool as spacer to prevent hyperextension of boot at toe break.
Transmetatarsal amputation: boot with long steel shank, metatarsal pad and stiff insole.
Lisfranc's amputation: boot filled with stiff insoleChopart's amputation: 1.syme's model
prosthesis 2. high collar shoe with toe filler
Syme's amputation: syme's prosthesisSyme's prosthesis should have end bearing pad for
shock absorption. Types1.full end bearing i.e. Conventional prosthesis: Has leather socket and wooden foot piece Most pts are unable tom bear long time standing
and distance walking2.CANADIAN SYME'S PROSTHESIS: more distal end
bearing and less proximal PTB weight bearing Medial window is given to pull bulbous end to the
socket. Also provides suspension over malleoli
SYME'S PROSTHESIS
3. closed expandable syme's prosthesis: more PTB bearing and less end bearing
Prescribed for modified syme's amputation where the lower end is less bulbous and there is no need for any window
Advantages: better cosmesis and better suspension
-Socket
-Suspension system
-Extension joints (knee assembly)
-Shank/pylon
-Terminal device (usually includes foot and Ankle )
Suction& Mechl close fitting
1. End bearing
– End of the stump bears the weight
2. Total Contact socket
– load is distributed to entire stump
– supports all the distal tissues within the closed system
– As there is total contact proprioception will be good.
– give good sensory feed back.
– good control of stump
– acts as a circulatory pump
– . During stance phase , positive pressure encourages venous return;
– during swing phase ,negative pressure encourages distal blood flow.
Socket WT bearing – 2 types
Total Contact socket– Used for most older patients– Offers “partial suction”– Suspended by pelvic belt and hip joint that is
attached to socket– A selsian bandage suspension preferred over
pelvic belt as the latter often interferes with sitting
suspension system -for attaching socket to body.
can be done bya)belt ,straps or cuff
b)others– by suction
prosthesis – by Mechanical
close fitting or silicon sock helps to maintain airtight seal
Silesian bandage
Hip joint,pelvicband waist belt
suspension system-Soft belts • Used as primary or auxiliary suspention• Traditional form is silesian belt
– Simple – disadvantage
• hygiene if it is non removable• Discomfort due to constrictive effect
• Total elastic suspension (TES)– New ,made ofelasticneoprene lined with smooth Nylon– Belt fits around proximal 8” of prosthesis
• Hip joint with pelvic band or belt– Provides rotational stability – significant mediolateral pelvic stability– Essential when abductors are week and amputees are obese
Silesian bandage
Hip joint,pelvicband waist belt
• held on by suction and close anatomical fit
• most suitable for above knee.
• eliminates the hip joint and pelvis belt or shoulder harness;
• permits free rotator motion about the hip
• and eliminates piston action of the stump in the socket , permitting greater toe clearance and smoother gait.
• No stump sock needed.
• closely fitted • create negative pressure
during the swing phase• and positive pressure that
expels air through a flap valve during the stance phase.
• The tight fit is applied at the upper two and half or three inches
and along the anterior wall of the socket, the reminder stump hangs free.
• A groove in the anteromedial wall accommodates the adductor tendons.
Suction socket prosthesis
Suction socket prosthesis
• Indicated for amputees for smooth residual limb contours
• Volume fluctuants such as weight gain and fluid retention– contraindications
Disadvantages • Difficulty in
obtaining press fit• Ocassional lossof
suction in sitting position
• No medium for absorbing perspiration
• Requirement of volume and weight stability
1. Axis system2. Friction mechanism3. stabilizers-
• Axis systemSingle axis ….
– Axis of prosthetic knee is same as that of weighty bearing axis
– Flexion easier, But stance phase control difficult
Posterior off set axis…– Axis of prosthetic knee is posterior – Flexion difficult, stance phase control easier
Polycentric….– variable center of rotation –advantage in both
phases
• Friction mechanismConstant friction
– Hinge to dampen knee swing– Allows single speed walking – Most used in children– Not used for older or weaker
Variable friction-cadence control– Staggerd friction pads
– More friction at extreme ranges,– Less friction at mid swing– Allows walkig at more speed ,but not durale
Medium friction Oil (hydraulic) frictionAir (pneumatic)frictionAllows best gait pattern –best for active patients-expensive
Medium friction
(hydraulic) friction
Constant friction
“ Intelligent prosthesis (IP)”
Programmed to each individual user during walking to achieve the smoothest, most energy-saving pattern.
Reacts to speed changes
Intelligence does not extend to understanding environmental considerations Ex. stairs, ramps or uneven terrain.
•utilizes electronic sensors•detect rate and range of shank
•Provides instant friction adjustments to changes in gait pattern
‘C-LEG’
Friction mechanism
• Stabilizers
Manual locking knee
left locked in extension,
unlocked whole sitting to permit flexion
Used in weak ,unstable patients primarily
StabilizersManual locking
1. Endoskeleton
“Modular prosthesis”
2,Exo skeleton:
Endoskeleton: “centrally located tubular structure
• made of prefabricated. Made of carbon fibers
• the load bearing structure
• The socket used over it• Adjustments can be
easily made • These are called
“Modular prosthesis”
• Exo skeleton:-conventional artificial limbs outer visible “skin” like -Inner hollow structures.-made of aluminum ,plastic -adjustments are difficult
-accurate measurement
should be there in the beginning it self.
• Providing contact between to the ground the foot provides shock absorption and stability during stance
• influences gait biomechanics by its shape and stiffness. This is because the trajectory of the centre of pressure (COP) and the angle of the ground reaction forces is determined by the shape and stiffness of the foot and needs to match the subjects build in order to produce a normal gait
pattern.
• The main problem found in current feet is durability, endurance ranging from 16–32 months [
• These results are for adults and will probably be worse for children due to higher activity levels and scale effects.
articulated
Non articulated
Non articulated
Ex:1)sach Foot (solid Ankle cushion Heal)
2)Madras foot -modified sach
–Post TA like look-sponge between heel&ground
3)Jaipur foot
4) dynamic -new
-spring in keel-energy stored and released
Articulated
SINGLE AXIS
MULTI AXIS
SACH Foot (solid Ankle cushion Heal)Some movementt in all directionsUseful when not used for heavy dutyWomen/childrenNot suitable for indian amputies barefoot/squating cannot
Jaipur foot • Mcr&vulcanised
rubber• Looks natural• Bare foot
walking/squating possible/crossleg/rough use
• 3level movmt• Inv/eversion possible
–hence can walk on uneven area
• Cheap-durable-water resistant
Single axis ankle and wood foot• Heavy duty activities, rapid plantar flexion at heal
strike
Commonly used varieties of prosthesis
AK prosthesispreferred design quadrilateral
socket –pelvic belt – Suction prosthesis
BK prosthesisPatellar tendon bearingMechanical Fit or with bar suspension system
Commonly used varieties of prosthesis
AK prosthesisquadrilateral socket
–medwall high,latwall flat10 deg adduction med inclination
pelvic belt Suction prosthesis
BK prosthesisPatellar tendan
bearing60%pt 40% condyles,post wallMed flare oftibiaalso wt bearing
Mechanical Fit or with bar suspension system
Slide the CROW into position, ensuring that the heel is fully seated within the CROW
The heel needs to be back all the way and in contact with the bottom of the footplate.
Check by looking along the sides and the back where it is separated above the heel.
Apply the front section of the device,
making sure it's sides overlap the back section
Apply the instep strap on the front of the ankle
Fasten all remaining straps
Skin should be checked for redness that does not go away after approximately 15 minutes.
Slight redness is common over the instep and under the ball of the foot.