Lower Limb Prosthesis

7/28/2019 Lower Limb Prosthesis

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Partial Foot Prosthesis

Physical Rehabilitation Programme

Manufacturing guidelines


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International Committee of the Red Cross

19 Avenue de la Paix

1202 Geneva, Switzerland

T + 41 22 734 60 01 F + 41 22 733 20 57

E-mail: [email protected]

www.icrc.org

ICRC, September 2006

All photographs: ICRC/PRP


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T of cott

Foreword 2

Introduction 41.Footprintosoundside 5

2.Castingandrectication 6

3.Sosocketabrication 7

4.Foreootbuild-up 11

5.Firstttingososocket 13

6.Drapingopolypropylene 15

7.rimlines 17

8.Fitting 20

9.Straps 21

10.Finishedpartialootprosthesis 22

Listomanuacturingmaterials 23

Manufacturing Guid el ines P art ial Foot P rosthesis


4/150 ICRC P hysical Rehab i l i tat ion P rog ramme

Forwor

T ICRC oro tcoo

Sinceitsinceptionin1979,theICRCsPhysicalRehabilitationProgrammehaspromotedtheuseotechnologythatisappropriatetothespeciccontextsinwhichtheorganizationoperates,i.e.,countriesaectedbywarandlow-incomeordevelopingcountries.

Tetechnologymustalsobetailoredtomeettheneedsothephysicallydisabledinthecountriesconcerned.

Tetechnologyadoptedmustthereorebe:

durable,comortable,easyorpatientstouseandmaintain; easyortechnicianstolearn,useandrepair; standardizedbutcompatiblewiththeclimateindierentregionsotheworld; low-costbutmodernandconsistentwithinternationallyacceptedstandards; easilyavailable.

Techoiceotechnologyisogreatimportanceorpromotingsustainablephysicalrehabilitationservices.

Forallthesereasons,theICRCpreerredtodevelopitsowntechniqueinsteadobuyingready-madeorthopaediccomponents,whicharegenerallytooexpensiveandunsuitedtothecontextsinwhichtheorganizationworks.TecostothematerialsusedinICRCprostheticandorthoticdevices

islowerthanthatothematerialsusedinappliancesassembledromcommercialready-madecomponents.

WhentheICRClauncheditsphysicalrehabilitationprogrammesbackin1979,locallyavailablematerialssuchaswood,leatherandmetalwereused,andorthopaediccomponentsweremanuacturedlocally.Intheearly1990stheICRCstartedtheprocessostandardizingthetechniquesusedinitsvariousprojectsaroundtheworld,orthesakeoharmonizationbetweentheprojects,butmoreimportantlytoimprovethequalityoservicestopatients.

Polypropylene(PP)wasintroducedintoICRCprojectsin1988orthemanuactureoprostheticsockets.Terstpolypropyleneknee-jointwasproducedinCambodiain1991;othercomponents

suchasvariousalignmentsystemswererstdevelopedinColombiaandgraduallyimproved.Inparallel,adurableoot,madeinitiallyopolypropyleneandEthylVinylAcetate(EVA),andnowopolypropyleneandpolyurethane,replacedthetraditionalwooden/rubberoot.

In1998,aercareulconsideration,itwasdecidedtoscaledownlocalcomponentproductioninordertoocusonpatientcareandtrainingopersonnelatcountrylevel.


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Ojctiv of t

TeICRCsManuacturingGuidelinesaredesignedtoprovidetheinormationnecessaryorproductionohigh-qualityassistivedevices.

Temainaimsotheseinormativemanualsareasollows:

opromoteandenhancestandardizationoICRCpolypropylenetechnology; oprovidesupportortrainingintheuseothistechnology; opromotegoodpractice.

Tisisanothersteporwardintheeorttoensurethatpatientshaveaccesstohigh-qualityservices.

ICRCAssistanceDivision/HealthUnitPhysicalRehabilitationProgramme


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Itroctio

Teaimothisdocumentistodescribeamethodorproducingpartial foot prostheses,workingwiththeICRCpolypropylenetechnologyandorthopaediccomponentsusedattheRegionalPhysical

RehabilitationCentreinBattambang,Cambodia.

Tecasting,recticationandalignmentmethodsusedcorrespondtointernationalprostheticandorthotic(P&O)standardsopracticeandarethereorenotdescribedintheseICRCmanuacturingguidelines.

Rr

Teproceduredescribedrelatestooneothemostcommontypesopartialootamputation,whichisalsoknownasChoppartormid-ootamputation.

Iullendbearingisnotpossible,thePatellar-endon-Bearing(PB)designbrimshouldbeused.

ICRC P hysical Rehab i l i tat ion P rog ramme



FOOTpRInT OF sOund sIde1

6Copythesound-sideootprintonasheetopaperandmarktheootrotation(~10).

Insertrontalline.

6Fixthepaperagainstawindowandcopythereversesideotheootprint.

Teprintwillhelpinpositioningthebuild-upotheootontheprosthesis.



CasTIng and ReCTIF ICaTIOn2

PatientassessmentandcastingareperormedinaccordancewithP&Ostandards.However,thecastistakenwhiletheamputeeissittingdown.

Patientswhowillhavetheirullweightbearingontheprosthesisshouldstandbeoretheplasterbandageshavehardened.Formoresensitivestumpsthepatientshouldstandonalayerosooam,andinecessaryaheelwedgemaybeaddedtocompensateorequinuspositionothestumportheheightotheshoeheel.

Caremustbetakentoensurethatthecalcaneusisheldinaneutralposition.

RecticationothepositivecastimpressionisperormedinaccordancewithP&Ostandards.

6Reerencelinescanbeaddedonthemouldsandtheootprint.


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2

1

3

Manufacturing Guid el ines P art ial Foot P rosthesis

sOFT sOCkeT FabRICaTIOn3

MeasurementoEVAoam:

Circumerence2cmabovetheheadothebula. Circumerencemiddleothecalcaneus. Lengthoplastercast.

Cutatrapezoidromasheeto6mmEVAoamaccordingtotheabovemeasurements.



4rima10mmstriponbothlateralsidesotheEVAoamtozeromillimetres.

4ApplyNeoprenecontactgluetwiceonbothtrimmedsides.

4Oncetheglueisdry,jointhetwosuracestoormacone.



4DusttheplasterpositiveandtheinsideotheEVAconewithtalcumpowdertoacilitatesliding.

4HeattheEVAconeinanovenorabout5minutesat120Candthenpullitovertheplasterpositive.

4okeeptheEVAoaminthesameshapeastheplasterpositive,secureitwithelasticbandagesorplaceitundervacuumuntilithascooleddown.


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FOReFOOT buIld-up4

4Gluelayerso12mmEVAoamcorrespondingtothelengthothesoundootmeasuredbeorecasting.

4Usetheootprinttakenbeorecastingtodeterminethecorrectootrotation.

Checktheanterior/posteriorandthelateral/medialalignmentsagainstthemeasurementcard(e.g.heelheight).

6Pre-shapetheoreootwithaknie.


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FIRsT FITTIng OF sOFT sOCkeT5

4Beorethepolypropyleneisdraped,thesosocketmustbecheckedon

thepatient.

Tesosocketmustberemovedromtheplasterpositivewithoutbreakingit.

Ontheposteriorside,puncha4mmholejustabovethecalcaneus.TishelpsavoidtearingotheEVAoamwhenthesosocketisbeingremovedromtheplaster.

Drawalineorusearulertomakeastraightcuttinglineuptotheproximalendothesocket.

Removethesosocketcareullyandkeeptheplasterpositive.

6ocheckthet,alignmentandlengthothesosocket,xitwithtape.



6Checktheheightotheprosthesisanditsstaticalignment.Makethenecessarymodications/correctionsbygrindingooraddingEVAoam.

6Checkalsothelengthandrotationotheoot,andadjustitasdescribedabove.

Atthispointitisnotrecommendedthatthepatientbeallowedtowalk,asthesocketandoreootaretooexible.However,theamputeemaytakesomestepsinsideparallelbarssothatthe

dynamicalignmentcanbechecked.



dRapIng O F pOlypROpylene6

4Putthesosocketbackontheplasterpositiveandstapleortapethesidesotheposteriorseamtogether.

4Measurementopolypropylenesheet:

Lengthromproximalpartoplasterpositivetotoes+15cm

Circumerenceoproximalpartososocket+2cm

Circumerenceomid-tibialsection+2cm

Circumerenceooot-ankle(belowmedialmalleoli,includingcalcaneus)+5cm

4Beoredrapingthepolypropylene,pullanylonstockingoverthesosocketanddustitwithtalcumpowder.



4Cuta5mmsheetoPPcorrespondingtothemeasurementstakenabove.

HeatthePPinanovenorabout20minutesat180C.

4LaythePPoverthemouldwithoutstretchingit.

Drapeitrstovertheankletowardsthemiddleanteriorpartotheprosthesis.Tenpullitaroundtheoreoot.

4FinishdrapingthePPandstickittogetheralongthemiddleanteriorsideotheprosthesis.

ightenthePParoundthesuctionconewithabicycleinnertube,aropeorastockingandopenthevacuumvalve.

4Withscissorsoraknie,cutotheexcessalongtheweldingseamwhilethePPisstillhot.

4Keepthevacuumonorabout5min.,butwaituntilthePPhascompletelycooleddownbeoreremovingthemouldromthevacuumcone.



TRIm lInes7

4Proximaltrimline: 1to2cmbelowthebulahead.

Lateral/medialtrimlines: On1/3otheproximaltibialsection,2to3cmwiderthanthe2/3distaltibialtrimline,whichisdrawnstraightupjustbehindthelateralandmedialmalleoli.

Distal/posteriortrimline: Alongthecalcaneustuberosity.

6Foreoottrimline: 5mmposteriortothe1stmetatarsaltodistalphalanges,butkeepthePPtiporprotectionotheEVAoam.


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4Removethesosocketromtheplasticsocket.Bearinmindthatitmightbedifculttoextracttheso

socketromthePPshell.


4Cuttheposterioropeningwithanoscillatingsaw.

4oavoiddamagingtheEVAoam,donotcuttheoreootopeningwithanoscillatingsaworknie.Instead,careullygrindito.



6GrindtheanteriorPPweldingseamdownto5mmandshapethetrimlinesotheplasticandsosockets.

6Shapealsothetrimlinesotheoreootopening.



FITTIng8

6Duringttingandgaittraining,xtheproximalpartotheprosthesiswithtape.

Modicationscanstillbemadetothealignment,especiallytocorrecttheeversionorinversiono

theoot,andtotheheelheightbyaddingEVAoamonthesole.

Itheprosthesisistoolong,compensateorthedierenceinlengtheitherinsidetheshoeoronthesoleothesoundleg.



sTRaps9

4PositionaVelcrostrap(width:25or40mm)justbelowthebulahead.

4FixthelooponthemedialwallandtheVelcrostraponthelateralwallwithtubularrivets.



FInIshed paRTIal FOOT pROsThesIs10



ICRC Code DescriptionUnit ofmeasure

Quantity

MDREBANDP12 Plaster bandages 12 cm Each According to stumpdimension

OMIS Plaster of Paris Each According to castdimension

OPLAEVAFERA03OPLAEVAFERA06OPLAEVAFERA12

OPLAEVAFKIN03OPLAEVAFKIN06OPLAEVAFKIN12

OPLAEVAFLIV03OPLAEVAFLIV06OPLAEVAFLIV12

EVA foam 3 mm, terra brownEVA foam 6 mm, terra brownEVA foam 12 mm, terra brown

EVA foam 3 mm, beigeEVA foam 6 mm, beigeEVA foam 12 mm, beige

EVA foam 3 mm, oliveEVA foam 6 mm, oliveEVA foam 12 mm, olive

Each According to castdimension

OHDWGLUENEO4 Glue, Neoprene contact Each According to soft socket

OMIS Tubular nylon stocking 60 mm for PP draping Each 1 length according toprosthesis

OPLAPOLYCHOC05

OPLAPOLYSKIN05

OPLAPOLYLIV05

Polypropylene 5 mm, terra brown

Polypropylene 5 mm, beige

Polypropylene 5 mm, olive

Each According to castdimension

OSBOSTRVP325

OSBOSTRVP440

Velcro strap with loop 25 mmor

Velcro strap with loop 40 mm

Each 1 length according topatient size

OHDWRIVET081

OHDWRIVET131

Tubular rivet 8 mm x 9 mmorTubular rivet 13 mm x 12 mm

Each 2

lit of fctri tri


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MISSION

The International Committee of the Red Cross (ICRC) is an impartial, neutral andindependent organization whose exclusively humanitarian mission is to protect thelives and dignity of victims of war and internal violence and to provide them withassistance. It directs and coordinates the international relief activities conductedby the Movement in situations of conict. It also endeavours to prevent suffering

by promoting and strengthening humanitarian law and universal humanitarianprinciples. Established in 1863, the ICRC is at the origin of the International RedCross and Red Crescent Movement.

Acknowledgements:

Jean Franois GallayLeo GasserPierre GauthierFrank JoumierJacques LepetitBernard Matagne

Joel NiningerGuy NuryPeter PoetsmaHmayak Tarakhchyan

and all prosthetists-orthotists who have worked in ICRC-assisted physical rehabilitation centres.


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0868/002

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200


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19 Avenue de la Paix1202 Geneva, Switzerland

T + 41 22 734 60 01 F + 41 22 733 20 57


www.icrc.org




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T ICRC oro tcoo













32/150Manufacturing Guid el ines Trans-Tibial Prosthesis

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ICRCAssistanceDivision/HealthUnitPhysicalRehabilitationProgramme


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Itroctio

Teaimothisdocumentistodescribeamethodormanuacturingtrans-tibial () prosthesesusingtheICRCspolypropylenetechnologyasappliedinICRCprojectsworldwide.



For short and medium stump, adult

Te alignment system and oot components are available in adult and child sizes.

Raw maTeRIals and COmpOnenTs1

4Description:

Convexankle

woconcavecylinders

Convexdisc

Cylindricalcup

5 Flatsteelwasherandcountersunkheadbolt

6 SolidAnkleCushionHeel(SACH)oot

7 Hexagonalheadboltandlockwasher



For long stump

Te alignment system and oot components are available only in adult size.

4PB(patellar-tendon-bearing)socketsecuredwithacususpension.Tesuspensioncanbeadjusted.

Incaseomedio-lateralinstabilityothekneeororastronghyperextension,athighcorsetwithsidebarsissuitable.

Tiscanbemadewithorwithoutasoliner.

Socket design

4Description:

Concaveankle

Convexdisc

Cylindricalcup

Flatsteelwasher

5 SolidAnkleCushionHeel(SACH)oot

6 CountersunkheadM10boltandthelockwasher



measuRemenTs and sOFT sOCkeT manuFaCTuRe2

6PB-SC(supra-condylar)

Shouldbemadewithasoliner.

6PB-SCSP(supra-condylar,supra-patellar)

Mustbemadewithasoliner.

6Tepatientisassessed,aprescriptionismade,measurementsaretakenandmouldingandrecticationareperormedaccordingtobestP&Opractice.


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Manufacturing Guid el ines Trans-Tibial Prosthesis

4Measuretheplastermould.Notethe: smallestcircumerence; largestcircumerence; length.

6Drawatrapezoidonasheeto6mmEVAaccordingtothemeasurementstakenbutadding3cmtothelengthontheshortsideothetrapezoid.

CuttheEVAandskivethelateralandthedistalsides(about12mm).


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6Applyglueonbothskivedsidesandormacone.Keepthetrimmeddistalsideontheoutsideotheconeandleaveitreeoglue.


Applytalcumpowderinsidetheconeandontheplastermodel.

Termoormingisdoneusingthevacuumpump,onaverticalsuctionhose.

HeattheEVAconeintheovenat120C.


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4Allowthesolinertocooldownorewminutes.

Removetheplasticbag.

Prepareapieceo6mmEVAtocoverthebottomedge.

Applygluetothetrimmededgeandthecovercap.

Heatthecapintheovenandmoulditonthesocket.

CutotheextraEVAandgrindtillsmooth.

Addpaddingabovethemedialcondyleandotherareasirequired.


6PulltheEVAconeovertheplastermould,keepingthegluedlineontheposteriorside,untilthetrimmeddistalsidecoincideswiththetipotheplastermould.

Coverthemouldwithaplasticbag,closeitsecurelybelowthemouldwithanelasticstrapandswitchonthevacuumpump.


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4Lastly,coverthedistalpartwitha3mmor6mmEVAcapandgrindtillsmooth.


TRans-TIbIal Cup alIgnmenT and s OCkeT manuFaCTuRe3

4Grindtheedgeothesocketcup.


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ait o t trtii c

4Fixthenailatthebottomothemould,wherethecupwillbeattached.

PlacethemouldontheCRalignmentjig;

alignaccordingtotheinstructionsontheuseothejig(separatemanual).Perormthealignmentinaccordancewiththemeasurementcard.Fixthecuptothesocketwithplaster.

4Fromthemiddleothecondyle,theplumbline

shouldpassabout1cminrontothecupaxis.



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mctr o t oct (4 oro)

mrt

4Whentheplasterhasset,smoothit.

4Add15cmtothemeasurement

takenatpatellalevel.


4Coverthesolinerwithanylonorcottonstocking.Removethenyloncoveringthecup.


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4FixaroundpieceoEVA(12+6mm)withanailinsidetheopeningothecup.


4Add15cmtothemeasurementtakenatthedistalpart.

4Add15cmtothemeasuredlengthothesocket.


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4Cutasheeto4mmPPcorrespondingtothesemeasurements.CleanthePPsheetandtheefonintheovenwiththinner.

Put the PP in the oven at 180C .

4Switchonthevacuumpump;drapethePParoundthesocket.

Weldingseamposition: orPPcosmetic:lateralormedial orEVAcosmetic:posterior

CutotheexcessPPwhileitis stillhot.

LeavethevacuumonuntilthePPcoolsdown.




6CutthePPaccordingtothetrimlines,removetheplasterwithoutdamagingthesocketlinerandPPsocket,andgrindtheweldingseamdownto3mm.

6Oncetheplasterisremoved,useascrewdrivertoremovethepieceoEVA.

6Grindthedistalpartandcheckthatthesuraceisfat.

Formaximumstrength,keepaminimumPPthicknesso2to3mmunderthecup.



buIldIng up The pROsThesIs and benCh alIgnmenT4

st to oo:

Ankle-ootbuild-upandalignment;

Socketbuild-up;Adjustmentolengthandweldingoconcavecylinderbutt;Finalbenchalignment.

6Te oot, the convex ankle and the concave cylinder are attached together.

Te window in the concave cylinder must be anterior.



aoot it

Anextra4mmplatemustbeattachedtotheconvexankle.DrilltwoholesasshownontheillustrationbelowandxthetwocomponentstogetherwithaPPweldingrod. Tis will preventbreakage o the oot bolt.

Coot



prrtio or fxtio

Attachtheconcavecylinder(withtheopeninginront)totheootandtheconvexankle.

Teheelheightisadjustedaccordingtothepatientsshoe;theconcavecylinder must beperpendicular to the ground.

Teoothasaheelheighto10mm(maximumheelheight:15to20mm).

Te ankle alignment system allows antero-posterior movements (fexion, extension).

Tis alignment system is used to adjust the angulation o the prosthesis accordingto heel height.

In any event, the concave cylinder must remain perpendicular to the ground.


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6Teootisadjustedin5to8externalrotations.


6Checkthealignmentonceagainwiththepatientsshoeontheoot.

6Tesocketisattachedtotheconcavecylinderwiththeconvexdiscinbetween.

6Teopeningintheconcavecylinderremainsinront.Tealignmentsystemisinneutralpositionorthersttting.



4Adjustthelengthaccordingtothemeasurementstakenonthepatient.

Marktheconcavecylinder

andsawotheexcess.

Cuttheconcavecylinderatanangleo90.

4Setthetemperatureothemirrorwelderbetween185and200C.

6HoldtheconcavecylindersonthemirrorwelderuntilarollomeltedPPorms.



6Careullybringthecylinderstogetherandapplyslightpressure.

Cocv cir corrct



Cocv cir icorrct

soct it

Tesocketisconnectedtoaconcavecylinderwithaconvexdiskinbetween.Teconnectionissecuredbyacountersunkheadboltandfatwasherinsidethesocket,withthe-nutinsidetheconcavecylinder.

Shiingcanoccurinalldirections:anterior,posterior,medial,lateralandcombinedmovements,witharangeo10mminalldirections

atrior iti Iiti oitio potrior iti



6Tealignmentsystemalsoallowsfexion,extension,abduction,adductionandrotation.

6BenchalignmentisperormedaccordingtoP&Opracticeandadjustedduringttingandduringthegaittrainingperiod.



6Beorethecosmeticismade,allthecomponentsmustbeweldedtogether.



pOlypROpylene COsmeTIC manuFaCTuRe5

TerearetwowaysomanuacturingaPPcosmetic.

5.1 Cotic it r rt o oct rov

ajtt o rt

6Drawalineollowingtheshapeotheoot,thendisassembletheoot.


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Minus

mm


4Checkyourmarkandgrinditcareully.

Checkoncemoreagainsttheoot.

4Stickadhesivetapeontheootanddrawalinewithapermanentmarkeronthetopotheconvexankleandonthetape.

4Disassembletheootanddrawalineallaroundtheplate4mmromtheedge.

Grindtheedgecareully.



4Checkagainwiththeoot.

Weldthetwoplatestogether,rstusingtheweldingirontomakeagrooveandthenweldingwiththehot-airweldinggun.

Grindagaincareully.

mctr o cotic

6Cutacrosstheprosthesisbelowthelevelothehamstringtendonsandremovetheupperpart.

4SkivethePPedgecareully.



4Addplastertoshapetheshank.

4Reducethecircumerenceotheshankby3cmtoalloworthethicknessothe4mmPPsheet.

Smooththeplaster.

Leavetheankleedgeree oplasterorthenalwelding.

4Fixthe4mmPPreinorcementplateat

thepopliteallevelwith2nails.

4Drawanylonorcottonstockingovertheplaster.

Addtalcumpowder.

Heatthe4mmPPsheetintheovenat180C.



4Glueornail5mmPPundertheankleplatetocompensateorretractionothePPaeropening.

6DrapethePPundervacuum.

6CutotheexcessPPattheweldingseam.Keepthevacuumonuntiltheplasticcoolsdown.



4Grindtheposteriorseamdownto2to3mm.Inthreeplaces,leaveawideroverlapoPPorholdingtheprosthesisduringwelding.

4Opentheseamcareullywithanoscillatingsawtoavoidbreakage.

6RemovethePPshellromtheprosthesisandremovetheplaster.Cleantheprosthesisthoroughlytoensurethatnopiecesoplasterremain.Puttheprosthesisbackintotheshell.



4HoldtheprosthesisinaparallelvicewithEVAorrubberprotectionbetweenthevicejawsandthecosmeticshell.Closethetwosideso

theposteriorseamwithlockgripsand/orothersuitabletools.

Beorewelding,makeV-shapedindentationsalongtheseamwithaweldingiron.

4Tenalweldingisdonewithahot-airweldinggunanda4mmPPweldingrod.

4Weldtheankletothe

shell.Aerwelding,careullyfattentheanklesurace.



4Polishwitharaspand/orasharppieceoglass.

4

Attachthe4mmPPreinorcementtotheshellwithtubularrivets.

Telaststepistoxtheootontheprosthesis.



5.2 Cotic it cot pp oct

ajtt o rt



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Minus

mm




4Stickadhesivetapeontheootanddrawalinewithapermanentmarkeronthetopotheconvexankleandonthetape.

4Disassembletheootanddrawalineallaroundtheplate3mmromtheedge.





Onceagoodthasbeenachieved,weldthetwoplatestogether:rstmakeagroovewiththeweldingironandthenweldwiththehot-airweldinggun.

Grindagaincareully.

4Roughenthesuraceothesocket.

4Covertheconcavecylinderswithadhesivetape.



4Shapetheshankwithplaster.

4Drawanylonorcottonstockingovertheprosthesis.

4Glueornail5mmPPundertheankleplatetocompensateorshrinkageothePPaerthermoorming.



6Drapeasheeto3mmPParoundthemouldundervacuum.

4Grindtheposteriorseamdownto2to3mm.Inthreeplaces,leaveawideroverlapoPPorholdingtheprosthesisduringwelding.

4Opentheseamcareullywithanoscillatingsawtoavoidbreakage.

4RemovethePPshellromtheprosthesisandremovetheplaster.Cleantheprosthesisthoroughlytoensurethatnopiecesoplasterremain.



4HoldtheprosthesisinaparallelvicewithEVAorrubberprotectionbetweenthevicejawsandthecosmeticshell.Closethetwosideso

theposteriorseamwithlockgripsand/orothersuitabletools.

Beorewelding,makeV-shapedindentationsalongtheseamwithaweldingiron.

4Tenalweldingisdonewithahot-airweldinggunanda4mmPPweldingrod.

4Weldtheankletotheshell.Aerwelding,careully

fattentheanklesurace.



6Grindtheseamdownto2to3mm.Polishwitharasporapieceoglass.

6Weldtheproximalpartotheprosthesis.

Telaststepistoxtheootbackontheprosthesis.Checkthefatnessotheankle.



eVa COsmeTIC manuFaCTuRe6

ajtt o rt




4Stickadhesivetapeontheootanddraw

alinewithapermanentmarkeronthetopotheconvexankleandonthetape.



4Dismantletheootanddrawalineallaroundtheplate,3mmromtheedge.

4Grindtheedgecareully.

4Roughenthesuraceothesocket.

For heavy patients, reinorce the concavecylinders with a 3 mm PP sheet.



4GluelayersoEVAontheprosthesis.

4Shapetomatchthesoundleg.

LeavetheankleplatereeoEVAorthenalcosmetic.

Bearinmindtheactthatanadditionallayero3mmEVAwillcovertheentireprosthesis,andthatthiswillincreasethecircumerenceotheprosthesisbyabout1cm.Atthisstage,checkyourcircumerencesbycomparingthemwiththemeasurementsnotedonthepatientstechnicalcard,andreducethesizeby1cmallover.



4Cutasheeto3mmEVAaccordingtothecircumerencesmeasured,butlongerthanthemeasurements.

Skivethesidethatwillbegluedontopotheoot.

SkiveonelongsideotheEVAsheetandapplygluetothatpart.

urntheEVAsheetover,andcoverthisreversesidewithglue.

4Applygluetotheentireprosthesis(excepttheoot).

Heatthe3mmEVAsheetintheovenat120Coraewsecondsuntilitbecomesveryfexible.DonotoverheattheEVAoryoumayaccidentallymakeprintmarksonitduringmanipulation.

akethe3mmEVAsheetoutotheovenand

glueitovertheprosthesis,startingbygluingtheskivededgealongtheposteriorsideotheprosthesis.

4Tenstartgluingthe3mmEVAsheetontheprosthesisbyrevolvingtheprosthesisonit,applyingconstanttensionontheEVAtoavoidairbubblesandolds.



4TelaststepistoremovetheexcessEVAandtogrindtheseamandtheproximaltrimlineotheprosthesissmoothly.


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ICRC Code Description Specifcation Unit o MeasureTrans-tibial module, child

OCPOMODUTTC Countersunk head boltFlat washer, steelTrans-tibial cupConvex discConcave cylinder with M8 T-nutConvex ankle

M8 x 60 mmD40 x d10 x H2.5 mmD70 x H26 mm

dia. 22 mm

1 piece1 piece1 piece1 piece2 pieces1 piece

Rrc it o tri

Coot: Trtii o, ci

ICRC Code Description Specifcation Unit o Measure

Trans-tibial module, adult

OCPOMODUTTA Countersunk head boltFlat washer, steelTrans-tibial cupConvex disc

Concave cylinder with T-nut M8Convex ankle

M10 x 60 mmD44 x d15 x H3 mmD70 x H26 mm

dia. 25 mm

1 piece1 piece1 piece1 piece

2 pieces1 piece

Coot: Trtii o, t

Weight per unit of measurement: 285 grams Quantity per box: 25 sets Box size: L40 x l30 x H44 cm

Weight per unit of measurement: 490 grams Quantity per box: 25 sets Box size: L40 x l30 x H44 cm



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ICRC Code Description Specifcation Unit o Measure

Trans-tibial module, long stump prosthesis

OCPOMODUTTLA Flat washer, steelTrans-tibial cupConvex discConcave ankle

D44 x d15 x H3 mmD70 x H26 mm

1 piece1 piece1 piece1 piece

Coot: Trtii o, o t roti

Weight per unit of measurement: 130 grams Quantity per packet: 1 piece

ICRC Code Description Specifcation

Feet or prosthesis

OCPOFOOT... Foot 22 28 cm, left and right,olive and terra colours

Heel, 10 mm

When ordering feet from 22 to 28 cm, change the number in the ICRC code and description.4With all the adult feet a M10 bolt and a M10 lock washer are included.4Weight per unit: (size 25) 605 grams Quantity per box: 25 pcs. Box L40 x l30 x H44 cm

OCPOFOOT... Foot 14 -21 cm, left and right,olive and terra colours Heel, 10 mm

When ordering feet from 14 to 21 cm, change the number in the ICRC code and description.4With all child feet a M8 bolt and a M10 lock washer are included.4Weight per unit: (size 19) 340 grams. Quantity per packet: 1 pc.

Coot: Ft or roti



77/150

Designation Used or

Materials

POP bandage 15 cm Cast-taking

POP powder Positive mould

Contact glue Soft socket

Soap (demoulding agent) Positive mould

Talcum powder Thermoforming

Vaseline Cast-taking

Nails Positive mould

Colorant for plaster Positive mould

Cotton/nylon stockinet dia. 8 or 10 cm Cast taking and soft socket

Cotton stockinet or sock Stump sock

Welding rod PP dia. 4 mm Welding components

Polypropylene 4 mm Hard socket

EVA 3 mm Soft socketEVA 6 mm Soft socket

Polypropylene cosmetic

Polypropylene 3 or 4 mm Cosmetic shell

Welding rod dia. 4 mm Welding cosmetic shell

Plaster powder Cosmetic shape

Adhesive tape

Tubular rivets (2) Posterior reinforcement

EVA cosmetic

EVA 3 mm; 6 mm; 12 mm

Contact glue

pp, eVa otr co


poro t: 2000 x 1000

str ct o oro t or ori rot

Trtii oct

4

Trtii cotic

3 or 4


78/150

MISSION



Acknowledgements:





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0868/002

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6

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trans-Femoral Prosthesis



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Tb of cott

Foreword 2

Introduction 41.Rawmaterialsandcomponents 4

2.Measurementsandsocketmanuacture 5

2.1rans-emoralcupalignmentandsocketmanuacture 6

2.2otal-contactprosthesis 11

3.Buildinguptheprosthesisandbenchalignment 15

4.Polypropylenecosmeticmanuacture 28

5.EVAcosmeticmanuacture 38

Reerencelistomaterials 41

Manufacturing Guid el ines Trans-Femoral P rosthesis



Foror

T ICRC oro tcoo













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ICRC

AssistanceDivision/HealthUnitPhysicalRehabilitationProgramme


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Itroctio

Teaimothisdocumentistodescribeamethodormanuacturingtr-fr (F) rthusingtheICRCspolypropylenetechnologyasappliedatthePhysicalRehabilitationCentrein

AddisAbaba.



rans-emoralkitsareavailableinadultandchildsizes.

6Contentsothekit:

SolidAnkleCushionHeel(SACH)oot

Hexagonal-headboltandlockwasher Convexankle Concavecylinderandpin5 Setowashers,nutandbolt6 Convexdisc7 Conicalcup8 rans-emoralcup9 Kneeshell

Raw maTeRIals and COmpOnenTs1



at, rt cti

measuRemenTs and sOCke T manuFaCTuRe2

4Tepatientisassessed,aprescriptionis

madeandmeasurementsaretakeninaccordancewithbestP&Opractice.

4AnegativecastistakeninaccordancewithusualP&Opractice.


87/1506

2.1 Tr-for c it oct fctr

4Temouldislledtoproducethepositive,whichisrectiedaccordingtothemeasurementstaken.

4Chamertheedgeothe

trans-emoralcup.




ait of t tr-for c

4Coverthemouldwithnylon.

Fixthenailatthebottomothemould,wherethecupwillbeattached.

PlacetheFmouldontheCRalignmentjig;alignaccordingtotheinstructionsontheuseothejig(separatemanual).Makethealignmentinaccordancewiththemeasurementcard.FixthecuptothesocketwithplasteroParis(POP).

4AddapieceoEVAatthedistalparto

thecup.

TiswillpreventthePPrombeingdrawninduringsuction.

Itwillalsoacilitateopening.


89/1508

4Cutasheeto5mmPPaccordingtothemeasurements(add5cmtothecircumerenceand10-15cmtothelength).

LeavethePPintheovenataround

180orabout20minutes.

DrapethePPonthemouldandopenthevacuumsuction.


4CutotheexcessPP.

LeavethevacuumonuntilthePPcoolsdown.

4Waitatleast6hoursbeoreopening.

Drawthetrimlineontheproximalpartothesocket.

UsetheoscillatingsawtocutthePP.

Removetheplaster.



4GrindthedistalpartothecupdowntotheEVApad.

UseascrewdrivertoremovetheEVA.

4Grindthedistalpartuntilitisfat. DonotremoveallthePP.

4Checkthatthesuraceisfat.

4Grindthedistalpartuntilitisfat.



4Grindthesocketalongthetrimlineswiththerouter.

4Useasharppieceoglasstosmooththeedgeothesocket.

4Usingaconicaldrill,maketheholeorthecottonstockingororthesuctionvalve.


92/150

6Positionthesuctionvalvemedio-laterallyanddistallytotheplastermould.Usethesuctionvalveringtoshapetheplaster.ReducethediameterotheplastertoalloworthethicknessoPPused(4or5mm).Smoothitnicelyandbreaktheedge.(see2.1,page6).

2.2 Tot-cotct roti

Terearetwowaysomanuacturingatotal-contacttrans-emoralsocket:

1.BythesameprocedureasoraconventionalF;

2.ByweldingtheconicalcupdirectlyunderthePPsocket.


4Coverthemouldwithanylonstocking.

Fixthecupwithplasterinthe

usualway.


93/150

3

12 6

3

Duringthersttting,glueapieceoEVAinsidethecupinordertoavoidairleakage.

Gluea12mmanda6mmpieceoEVAinsidethecup.Finally,usea3mmpiecetocoverthecupandthesidesothecup.


6Materialneededornishing.

6Gluethe12mmand6mmEVAdiscsinsidethecup.

6Lastly,gluethe3mmEVAallaroundthecup.


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4Drillaholeaccordingtothediameterothesuctionvalve.


4Smooththeedgewithasharppieceoglass.

4estthesuctionvalveandcheckbyaddingwaterinsidethesocket.



4Itheconicalcupisused,itmustbeadjustedtothesocketinaccordancewiththealignment.

Usetheweldingirontomakeagroovebetweenthesocketandtheconicalcup.

4Usethehot-airweldingguntoweldthecuptothesocket.

Tishastobedoneverycareullytoavoidbreakageduringthersttting.


96/1505

6Componentsfr 6 k ic y.

a-foot it

Anextra4mmplatemustbeattachedtotheconvexankle.(Fr 6 k ic y.)

DrilltwoholesasshownontheillustrationbelowandxthetwocomponentstogetherwithaPP

weldingrod.(Fr 6 k ic y.)

Ti wi rvt brkg f th ft bt.


T bii- bc it roc t to foo

Ankle-ootalignment

Socketalignment Adjustmentolength Weldingocylinders Alignmentonishedprosthesis

6Preparationbeorexation fr 6 k ic y.

BuIldIng up The pROsThesIs and BenCh alIgnmenT3


97/1506

6Formaximumstrengthotheassembly,theopeningotheconcavecylindermustbeinront,andthereinorcementbarattheback.


6Fixationprocedure.

6Finalresultfr 6 k ic y.


98/1507

Teanklealignmentsystemallowsdorsalandplantarfexion,medio-lateralmovementssothattheprosthesiscanbeadjustedtotheheelheightotheshoe.

Tealignmentcanbeadjustedoraheelheightobetween0mmand20mm,butaheelheighto10mmisrecommended.

Teheelheightisadjustedaccordingtothepatientsshoe;theconcavecylinder ut bricur t th gru.


4Teootisadjustedinexternalrotationso5.

4Checkthealignmentonceagainwiththepatientsshoeontheoot.


99/1508

4

ranserthismeasurementromtheootuptothemechanicalknee-jointaxis.


k--foot it

6Samemeasurement.

4Temeasurementtakenonthepatientmustberomthemedialtibialplateauplus1.5to2cmtotheground.



4Drawalinewithamarkeraccordingtothemeasurementtaken.

Makeanothermark9cmromtherst.Tiscorrespondstothebottomotheconcavecylinderminus1cm.

4Usethepipecuttertomakethecut.

Smooththeedges.

4Payspecialattentiontotherotationotheknee-jointwiththeoot.

Heatthedistalpartothepipewiththe

hot-airweldinggun.

Usearubbermallettoinserttheknee-jointintotheconcavecylinderasarasthemark.



soct bc it

lt jtt for or t t

Tesocketisconnectedtotheconicalcup(aerlengthadjustment)withaconvexdiscinbetween.Teconicalcupisweldeddirectlyontopothekneejoint.Teconvexdiscallowsabduction,

adduction,fexion,extensionandshiinginalldirections.

6Checkthealignmentandadjusttheconicalcupaccordingtothemeasurementstaken.

C oi i frot

CORReCT

C oi t bc

InCORReCT



6Teorcepatternsonheelstrikeareasshownintheseillustrations.Breakagescanhappeneasily.

6Makesuretheconicalcupremainshorizontalinbothplanesbeoreweldingit.Checkalsokneealignmentandootrotation.



4Tetemperatureothemirrorshouldbebetween185and200C.

4Holdthecylinderonthemirrorwelderornomorethan5minutesuntilarollomeltedPPisormed.

Weldaccordingtothemarksandapplyslightpressure.

wi t cir



lt jtt for ort t

1.Tesocketisconnectedtotheconicalcupwithaconvexdiscinbetween.2.Tesecondconicalcupisconnectedtotheknee-jointwithanotherconvexdiscinbetween.3.Oncetheheighthasbeenadjusted,theconicalcupscanbeweldedtogether.

Staticordynamicalignmentcanbedoneeitherabovetheknee-jointorbelowthesocket.

lt jtt for o t: p tttio to ii iio ( bo)

A 22mmorconvex/concaveplatesB 40mmminimumdistancebetweenconnectionsuraceandaxisotheknee

A=22mm(minimum)

B=40mm

Dimensionstobedetermined:

A deviceoradjustingalignment

B distancebetweenupperpartotheknee-jointandkneeaxis

A B


107/1506

med. la. an. pos. an. pos.

an. pos. an. pos. med. la.

Fi roti it

6ModularPPtechnologyallowsslidingandtiltingduringalignment.


ntr oitio Fxio extio

6Backwardoranteriorshiingispossible.Shiingcanalsooccurmediallyorlaterally.



Bt fctr

Duringtherstttingwiththepatient,themeasurementorthebeltistakenromthegreattrochanter,aroundthewaistandabovetheoppositeiliaccrestasarasScarpastriangle.

Tebeltcanbeeitheraleatheroracottonstrap,xedwitha16mmbuckle.

Add15cmtothemeasurementtakenonthepatienttoalloworadjustmentduringtting.



pOlypROpylene COsmeTIC manuFaCTuRe4

6Allcomponentshavetobeweldedtogether.

6Drilla5mmholeintheconcavecylinderandthepipe.

6Fixtheexpansionpin.



4RemovetheexcessPPornishingattheankleplate.

4Drawalineollowingtheshapeotheoot.

4Disassembletheoot.


111/1500

Minus

mm


6Checkyourmarkandgrinditcareuly.Checkoncemoreagainsttheoot.

4Stickadhesivetapeontheootandmakeamarkwithapermanentmarkeronthetopotheconvexankleandonthetape.

4Removetheootanddrawalineallaroundtheplate4mmromtheedge.





Onceagoodthasbeenachieved,weldthetwoplatestogether:rstmakeagroovewiththeweldingironandthenweldwiththehot-airweldinggun.

Grindagaintoobtainasmoothnish.

6Forheavyandactivepatients,astripo3mmPPcanbedrapedaroundtheconicalcupandalignmentsystemorextrastrength.Useanelasticbandagetotightenitwell.



4WhenthePPhascooleddown,grindtheedgesandweld.

4Protecttheknee-jointwithadhesivetape.

Grindthesocketwithsandpapertoroughenit.

FillthesocketwithPOPinordertoxthepipe.



4Shapethesocketwithplasteraccordingtothemeasurement.

4Smooththeplasterandcoveritwithastocking.

4Drape4mmPParoundthesocketinthesamewayasortherstsocket.



6OncethePPhascooleddown,removetheproximalpart.

Usetheoscillatingsawtoopentheseam.

Removetheplasterandcleanupthesocket.

rimtheshellproximallyanddistallyinlinewiththesocketandtheknee-joint.

Replacetheshellonthesocket.

Weldtheseam.

Weldtheproximaledge.

Weldtheshelltotheknee-joint.



4Whentheweldingiscompleted,removetheexcessPP.

Grindtheseambetweentheshellandtheknee-joint.

Teseammustbeground

almostfushwiththesocket. Grindtheproximaledgeothesocket.

Tesethreepartsmustthenbepolished.

4Protectthepipeandtheknee-joint

withtape.

4ShapetheshankwithPOPanddrapeasheeto4mmPPoverit.



4Opentheshellandremovetheplaster.

4Inserttheprosthesisintothecosmeticshell.

Determineandgrindthe

proximaltrimlineormaximumfexionotheknee-joint.

4Weldtheseamandtheankleconnection.



4Grindandsmooththewelding.

6InsertanEVAwashercuttothesameshapeastheshankabout10cmbelowtheknee-jointtokeepthecosmeticshankinplace.Tiswillalsopreventcreaking.

4

Fixtheknee-jointbackontotheshank.

Fixthebelt.



eVa COsmeTIC manuFaCTuRe5

6RoughentheEVAbeoreapplyingittothePPsocket.GluelayersoEVAonthesocketandshapeit.Anallayero3mmEVAwillcovertheentireprosthesis,increasingthecircumerenceby1cm.

4Cutasheeto12mmEVAcorrespondingtothecircumerenceothewoodenorplastermodelshank.SkivebothsidesotheEVAandglue.



4PlacethesheetoEVAintheovenatabout120untilitbecomesso,thenbendittoobtainaconicalshape.Addtalcumpowderinsidetheconeandputitbackintheoven.

4PulltheEVAconeoverthemodelshankandtightenitwithanelasticbandage,oruseavacuumsystem.

4Cuttheposteriorproximaledgetoallowfexionotheknee-joint.



4i:ornishingpurposes,windatapearoundtheproximalaspectotheoottopreventdamagetotheootcosmeticduringgrindingotheEVA.

4Shapetheshankaccordingtothemeasurementstakenonthesoundleg.Tenglueitdistallyontopotheoot.

InsertanEVAwashercuttotheshapeotheshankabout10cmbelowtheknee-jointtokeepthecosmeticshankinplace.

Fixtheshanktothesocket.Fixthebelt.



Rfrc it of tri



Designation Used for

Materials

POP bandage 15 cm Cast-taking

POP powder Positive mould

Contact glue Soft socket

Soap (demoulding agent) Positive mould

Talcum powder Thermoforming

Vaseline Cast-taking

Nails Positive mould

Colorant for plaster Positive mould

Cotton/nylon stockinet dia. 8 or 10 cm Cast-taking

Cotton stockinet or sock Stump sock

PP welding rod dia. 4 mm Welding components

Polypropylene 5 mm Hard socket

Polypropylene cosmeticPolypropylene 4 mm Cosmetic shell

PP welding rod dia. 4 mm Welding components

POP powder Cosmetic shape

Adhesive tape

EVA cosmetic

EVA 3 mm; 6 mm; 12 mm

Contact glue

pp, eVa otr cob


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0868/002

09/200

6

200


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alignment Jig For

lower-limb Prosthetics




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Tb of cott

Foreword 2

Introduction 41.Useothealignmentjig 5

1.1Descriptionothejig 5

1.2Possiblemovementsorpositioningthepositiveinspace 6

2.Installationothejig 8

3.Choiceandlocationocentringaccessories 9

4.Someexamplesouse 11

4.1rans-tibialsockets 11

4.2rans-emoralsockets 13

Manufacturing Guid el ines Al ig nment J ig for Lower-L imb P rosthet ics



Forword

T ICRC poypropy tcooy













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Obctiv of t u





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Itroductio

Everymanuacturingtechniquehasitsownspecicrequirements.TetechniquebasedontheuseopolypropylenewhichhasbeendevelopedbytheICRCsphysicalrehabilitationprogrammeisalso

subjecttothisrule;itmustcombinequality,easeouseandlowcost.

Tecomponentsortrans-tibial()andtrans-emoral(F)prosthesesproducedbyCREquipementsSA(CRE)alloworcertainangularandtranslationadjustments,butthesepossibilitiesarelimited: 20mmintranslationorsliding(2x10mmeachsideromtheneutralpoint) 20degreesintilting(2x10oneachsideothemedianaxis).

Itisadvisabletoretaintheseadjustmentpossibilitiesordynamicalignment,andtotakeintoaccounttheactthatstaticalignmentollowstheweight-bearingreerencelinestoachieveaneutralposition.

Inmostothetechniquesusedorsocketmanuacturewithpolypropylene,theconnectioncomponent,calledthecup,isincludedinthesocketduringthethermoormingphase.Itisthelinkthatholdstheotherpartsotheprosthesistogether.UsingthistechniquemeansthatthealignmentmustbeadjustedBEFOREthesocketthermoormingprocess.

Anothertechniqueallowstheproductionoull-contactsockets.Faultypositioningotheconnectingcomponent(thesocketcup)duringweldingmakesalignmentdicultorimpossibletoachieve.

Particularattentionmustthereorebepaidtowhethertheconnectingcuporsocketcupisplacedonthepositivebeoreoraerthethermoormingphase.

AspecialtoolhasbeendesignedandmanuacturedbytheICRCandCREtohelpprostheticandorthotic(P&O)technicianscompletethesealignmentphaseseasilyandwiththerequiredprecision.

Tistoolisthealignmentjig.

Obctiv of ti docut

Tepurposeothisdocumentistodemonstratetherelevanceanduseulnessothealignmentjigor

obtaininghigh-qualityresults.

TealignmentprinciplesappliedarebasedoninternationalP&Ostandards.

Rrk

TisdocumentisnotatechnicalmanualonthemanuactureoandFprostheses.




1.1 Dcriptio of t i

Tealignmentjigisastainlesssteelrameabout2metreshighand0.8metreswide.Itissturdyand

stable.

Use OF The alIgnmenT jIg1

Poitioi p Fitio p

6Tepurposeothejigistoacilitatethepositioninginspaceothepositiveplaster,andtoholdtheconnectioncup(orsocketcup)rmlyandpreciselyduringtheoperationtoxittotherectiedpositivewithplaster(orbywelding).

Obviously,thisxationphaseisindependentothetypeosocketused:theillustrationshowsprostheseswithandwithoutsosocket.


138/150

4Inthecentreothejigtherearetwocomponentswhichallowthepositioninginspaceandimmobilizationotheplasterpositiveinrelationtothepositionotheconnectioncup.

Atthetop:theballandsocketjoint.Tisallows: suspensionandimmobilizationothepositive;

rotationaroundthepipeaxis; orward,backwardandlateralmovements.

Below:thetray.Tisimmobilizestheconnectingpart(cuporsocketcup).

Teheightothetrayisadjustable.Itisxedonaverticalaxis,whichrepresentsthelegpartotheutureprosthesis.

ohelpthetechnicianvisualizethecomponentpartsotheutureprosthesis,aprostheticootisxedtothelowerendothisaxis.

Tealignmentprinciplesare

independentoheight.


1.2 Poib ovt for poitioi t poitiv i pc

4Longitudinalmovements.

4Lateralmovements.

4Ballandsocketrotation.



4Lockingolongitudinalmovements.

4Gradientothepipe.Tepipecandescribeaconeoabout30atthesummit

(about15aroundtheverticalline).

4Teballandsocketallowscorrectpositioningothepositiveevenwhenthepipeiswronglyplaced.

4Ballandsocketdetailsandblockingscrew.

Lockingorotationandgradientothepipecarrier.

Lockingolateralmovements.

ighteningothepipe.


140/150

woprecautionsmustbetakenbeorestartingtousethejig:

Checkwithaspiritlevelthatthecentralbeamsupportingtheverticalaxis(whichinturn

supportsthetray)isperectlyhorizontal,andmakeanynecessaryadjustmentsbymeansotheadjustableeet.

Installplumblinesbeyondtherangeomovementsothepipecarrier.

Byestablishingrontalandsagittalplanes,theseplumblinesallowexactapplicationotheprinciplesoalignment.

InsTallaTIOn OF The jIg2

4Frontalandsagittalplanesareestablishedwithplumblines(4x)beyondthe

movementsothepipecarrier.

4Checkwithaspiritlevel

thatthecentralbeamisperectlyhorizontal;adjustbymeansoadjustableeet.




(A)T try

ChOICe anD lOCaTIOn OF CenTRIng aCCessORIes3

4Tetrayhas3holesM8.

Teholesituated2cmromthecentreisusedoradultFalignment

Tecentralholeisusedoradultandchild.

Teholesituated1cmromthecentreisusedorchildF.

WhenusedoradultF,thepositivesagittalplanisperpendiculartothecentralbeam,andwhenusedorchildF,themainlineothisbeamisthesameasthepositivesagittalplane.

Poitiv frot for dut iz

Positivefrontforchild-sizeBK

(B)Productio by of t cup (u of t ctri cyidr)

Poitiv frot

Poitiv rr

6Adultandchildalignment. 6AdultFalignment.


142/1500

Poitiv frot

Poitiv rr

6Fchild-sizealignment. 6Teconnectingcuponthetray.

(C)Productio by of t ockt cup

Tesocketcupmakesitpossibletomanuactureull-contactsockets(withcontactontheentiresuraceothestump,includingtheextremity).

Teprinciplesarethesame;onlytheaccessoryisdierent.

6Teaccessoryorcentringthesocketcupispositionedorinthecentralhole.

6TesocketcupispositionedoradultF.

5Centralbeammainline.




sOme examPles OF Use4

sockt witout tri cotct

Teconnectioncupisassembledwiththepositivebeorethesocketthermoormingoperation

(methodmostrequentlyused).

. TT sockets

(A) ait of ort TT poitiv (rit)

6Posteriorview:Tepictureistakenothepositivewithoutsosockettomaketheshapesandmarksothepositivemoreclearlyvisible.Tepresenceorabsenceoasosockethasnoeectonthealignmentprinciples.

Viw bfor oii Viw ftr oii


144/150

6Lateralview:

Viw bfor oii Viw ftr oii

(B) ait of o TT poitiv (ft)

ltr viw bfor oii Potrior viw bfor oii




. TF sockets

(A) Prtr to b obrvd btw t CRe k d t it i

a=22mm(minimum)

b=40mm

Dimensionstobedetermined:

a deviceoradjustingalignment

b distancebetweenupperpartothekneeandkneeaxis

a b

6Tereisa2cmgapbetweenthesocketxationscrewandthekneeaxistotakethefexumintoaccount.

6Tekneeaxisisonthesameverticallineasthepipe(thepartbelowtheknee).

Tesamepositioningeaturesareoundonthealignmentjig.


146/150

(B) lo tup

6Itispossibletoadjustthedistanceromischiumtokneewhentheconnectioncupisbeingxedbycalculatingheightainadvanceaccordingtothedetailsgivenabove.

Potrior viw bfor oii sid viw ftr oii

a




(C) sort tup

Full-contact sockets

Teconnectingelement(thesocketcupinthiscase)isassembledwiththesocketaerthethermoormingoperation.

Warning:Specialcaremustbetakenwhenthesocketcupisusedastheconnectingcomponentwiththecontactsocket,orthesaetyothepatient.Indeed,inordertostrengthentheweldingbetweensocketandcupaerthermoorming,thesocketmustbecareullyadjustedasshownintheillustrationabove.

Ten,toensurethepatientssaety: theweldingshouldbeperormedwithparticularcare;

thepatientshouldnotbelealoneduringthettingandrehabilitationphases; polypropylenemustbeusedornishingsoastoormanexoskeletonthatguaranteesthesolidityotheprosthesis.


148/150

Tesocketcupiseasytouse: Alignthesocketaccordingtothepossibilitiesoeredbythejig. Installinthetraythecentringdevicedesignedorsocketcups. Cutthesocketcupatthedesiredlengthandgiveittheappropriateshape. Weldthesocketcuptothesocketlightlywithaweldingiron. Removetheassemblythusobtained.

Endwithcareulwelding.

(A) TT ockt

sort TT ockt (id viw) lo TT ockt (potrior viw)

sort TF ockt (potrior viw) lo TF ockt (id viw)

(B) TF ockt



149/150

MISSION



Acknowledgements:





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Documents

Lower Limb Prosthesis