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BI – LATERAL TRANSTIBIAL PROSTHESIS

BI – LATERAL TRANSTIBIAL PROSTHESIS. JACO DEIST DEIST & VD SPUY ORTHTISTS. INTRODUCTION. My patient is a women with a bi – lateral trans tibial amputation due to diabetes.

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BI – LATERAL TRANSTIBIAL PROSTHESIS

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  1. BI – LATERAL TRANSTIBIAL PROSTHESIS JACO DEIST DEIST & VD SPUY ORTHTISTS

  2. INTRODUCTION • My patient is a women with a bi – lateral trans tibial amputation due to diabetes. • She has been walking for the past 17 years on a PTS system with Endolite Multiflex feet. We had great success up to now, but we wanted to change her to a more up dated system. • She is an active walker and wants to live life to the fullest. She likes dancing and walks a lot. • I introduced her to the Iceross seal in liner system and the Elattion feet. • She was a little bit uncertain to make such a dramatic change, but she was willing to give it a try. • She was also excited that she could now wear shoes with different heel heights.

  3. CASTING PROCEDURE • My patient was fitted with the correct size liners. • Prior to casting, the necessary measurements were taken. • I first casted from the patella tendon to the distal end of the stump with 150mm elastic bandage • The elastic bandage gives a very good print of the stump and of the HSM of the liner. • In this way I also allow myself to concentrate on a smaller part of the stump and I have to work on less crucial areas at a time.

  4. CASTING PROCEDURE • I then applied a 200mm non elastic 5 layered slab. • As her previous prosthesis was a PTS system (for the past 17 years) I wanted to give the socket a higher proximal brim, and therefore I concentrated to get a good mould over the proximal aspect of the condoles. • Before I applied the slab, I applied Vaseline on the plaster of the medial condole, to be able to lift the slab and remove the cast.

  5. Cast rectification • I reduced the cast in the prescribed manner. • Measurements were confirmed and ML’s were checked • She has a prominent distal end of the Tibia on both stumps, as shown on the slide. • Despite this fact, I still removed plaster over this area of the seal.

  6. Cast rectification • The minimum build ups were done and the positive moulds were draped with Orthochuck.

  7. Test sockets • The prosthesis were aligned according to the prescription of the specific feet. • We also foamed the distal end of the sockets, to be able to shift the sockets anterior posterior and medial lateral.

  8. Fitting the prosthesis

  9. Fitting the prosthesis • As seen on the previous slide and this one, the HSM has formed an excellent seal. • I gave good support between the Tibia and Fibula to prevent any loss of vacuum when seated. • The brim fitted well proximal. • At the end the patient was happy with lower trim lines.

  10. Dynamic alignment

  11. Socket fabrication • The test sockets were filled and draped with a 10mm soft surlyn. • We then laminated 6 layers of material and 1 layer of tube carbon

  12. Definitive socket and cosmesis • My patient walked with the definitive sockets for a weekend. Initially we really struggled to don the prosthesis, and my initial thought was that it might be a little bit to tight. After she has warn them for half a day, the prosthesis started pumping air and we were able to don the prosthesis with a 1 ply sock. • I learned from this experience that when working with a diabetic patient, and a patient that has never warn a silicone sleeve before, that it is important to give the patient a silicone sleeve to wear a day or two before you start casting, to ensure that all possible swelling and edema is removed. • It was very important for me to give the patient a cosmetically accepted prosthesis, as she is a women and the cosmesis is important to her, and for this reason we covered the prosthesis with flex - skin. • In the latter stages of the cosmetic process, I have realized that I should have placed the valves more distally, as the upper edge of the valve protruded the calf. • In the slides to follow, different stages of the cosmetic procedure is shown. • The one positive part of being a bi – lateral amputee, is that one is able to manufacture two “legs” that looks very much the same, and it is difficult to notice that the person is actually wearing false limbs!

  13. Definitive socket and cosmesis

  14. Final phase

  15. Happiness is:

  16. Advanced moves:

  17. The end!! • My patient was extremely happy and adapted well from her old prosthesis to her new seal – in liner system with Elation feet. The first thing she bought was shoes with high heels, and the Friday night, they had a dancing marathon from 18H00 – 24H00!! • This is a good way of showing that modern technology has moved forward in favor of the patient

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